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“.
Certain foods have also been found to aggravate or worsen hair fall, such as sugar, which triggers the overproduction of the male hormone, androgen, which in turn causes the hair follicles to shrink in size and for hair to fall out or stop growing. Fish products that are known to contain high levels of mercury like tuna, mackerel and swordfish can also cause hair weakening and excessive hair fall. Studies have also found that fried foods are associated with the production of high levels of DHT.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
Dupilumab is FDA approved for treating eczema aka atopic dermatitis and sold under the brand name Dupixent.  As the story goes, a patient with alopecia totalis (a form of areata which leaves a person’s head completely bald) was being treated for eczema by the drug Dupixent. After 6 weeks the patient first began to notice progress in terms of hair growth and at 7 months she had noticeable pigmented hair growth on her scalp. Notably, the patient stopped taking the dupilumab for a period of time and noticed her growth subsided; when she began taking the drug again the hair improved once more. This provides another useful therapy option for patients seeking treatment for AA. One would imagine a topical version would be worthwhile to investigate.
Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
A diet that is poor or lacking in certain nutrients, particularly iron, protein, and vitamin B, which are essential in the production of keratin, can cause a long telogen phase and a very short anagen stage. On the other hand, excess supply of vitamin A in the body, especially those taken through supplements, can prove to be toxic and can cause a range of adverse body effects including loss of appetite, fatigue and consequently, hair loss.
Consider other factors besides color. Color is important - your wig or hair piece should match your natural hair to look natural. However, consider also texture. You wig should feel like real hair; it should have a smooth and silky feel. For those that need full coverage, choose a wig that bounces to give the illusion of volume. A wig that has a lacing that fits your natural hair also helps in making sure that you have a more natural looking hairline.
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).

Hair loss is something that affects a huge proportion of men, and yet unfortunately there is no cure. Though you may have heard of certain medicines such as Propecia (finasteride) or Regaine (minoxidil), it is far more accurate to think of these medicines as effective long-term treatments. There are interesting experimental options being trialled currently, yet these established treatments can be effective at preventing hair loss in up to 90% of men.

Disruptions in the normal length of each phase, which can cause hair loss and hair thinning, may be the result of a number of internal and external stimuli. These are also what we call the triggers and causes of your hair loss. As a quick example, dieting can leave the body stressed and in need of important nutrients. Because of this stress, hair growth may be cut shorter than usual and there is an early onset of telogen or shedding of hair.


Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, said that Rogaine works better on the top and crown (for reasons not fully understood, the frontal hairline tends to be more resistant to treatment) and ideally should be started as soon as women notice thinning. “Any regrowth you get is a minimal amount,” Dr. Piliang said. “So the more density when you start, the better results you get.”
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.
“Once that hair has stopped shedding, it does regrow, at a rate of about a centimeter a month,” said Dr. Senna, who suffered from the condition after each of her pregnancies. She shares photos of herself with patients, to show she can sympathize. In one, her entire frontal hairline clearly is growing back in. “If I’d used a treatment, I would have thought it was a miracle drug,” she said.
Kuntzman described the “snake oil” era of hair restoration, in the early twentieth century, when salesmen offered nonsense treatments, often with horrific results. One involved “cylinders of skin taken from the abdomen and sewn into your scalp to function as a sort of belt loop” for new hairs, Kuntzman said; another used paraffin injections that left some customers with lifelong horn-like head bumps. Most of the really ugly stuff ended in 1938, when the Food and Drug Administration began regulating the industry.
You always hear these stories about people who take a homeopathic approach to fighting baldness. It’s always some off-the-wall remedy like smearing a paste of ginger and cayenne pepper on your scalp three times a day or eating a special type of ginseng farmed only in a rural village in Tibet. We'll go on the record to say that it's highly unlikely that these remedies work at any level.
2. High-tech regrowth therapies. Laser treatments ($200 and up) expose hair to low levels of laser light, which boosts hair growth by increasing the amount of adenosine triphosphate (ATP) in hair follicles. ATP provides energy to hair-follicle cells, so the more of it that’s around, the more energy hair follicles can use to grow your hair. Sadick says three months of weekly sessions are best when you’re kick-starting a hair-loss treatment.
In 2013, RepliCel began working with the Tokyo-based Shiseido Company, Limited—a Japanese multinational skin care, hair care, cosmetics and fragrance producer—on a collaboration giving Shiseido an exclusive geographic license to use RepliCel’s RCH-01 hair regeneration technology in Japan, China, South Korea, Taiwan and the ASEAN countries representing a population of approximately 2.1 billion people. “Shiseido and RepliCel will collaborate on the continued improvement of the technology and will conduct human clinical trials in each of their territories with the goal of commercializing a safe and effective hair regenerative treatment to help those suffering from pattern baldness and thinning hair,” Buckler said.

Hair Surge contains three key ingredients: caffeine, ketoconazole, and saw palmetto. As already mentioned, all three are essential ingredients in any shampoo that’s truly targeted for hair growth. It doesn’t contain biotin, but you can always take biotin as a supplement if you absolutely feel that you have to have it. Besides, if you still have doubts that Hair Surge actually works, you can sift through the thousands of positive comments and testimonials about it online.
It is called the vampire treatment because blood is taken from the patient that removes the platelet rich plasma. Then, the PRP is injected back into the scalp. This energizes the scalp with new active blood flow. Treatment is available at select clinics but widespread adoption may become the norm. It is less invasive than hair transplants but costs more if you count the cost of doing many sessions.

I hope you’re all having a good Friday and feeling good out there. Two weeks ago I posted my first “Feel Good Friday” update which contained a hilarious video of Deion Sanders showing off his new hairline from a 5,000+ FUE procedure he had in 2017. That video is now unable to embed because its owner changed his account to private. Coincidentally, a week after I shared that video I noticed that Deion posted a new video to his own Instagram account of him going back to his clinic for another FUE hair transplant to “comeplete his comeback”, in his own words.

For the first twenty years of my life, I took having hair for granted. One day, in college, I woke up and looked in the mirror, and was convinced that my hair was falling out. Not receding—dropping, that minute. Later that day, I told a roommate. He took a beat, and then asked, not without kindness, “Were you on PCP?” That semester, in a creative-writing workshop, I was moved enough to write a long, confused story about a teen-ager with male-pattern baldness who suffers a meltdown and robs the hot-dog counter where he works. By my late twenties, hair loss was something that I thought about all the time. I understood, largely, that my obsession was a specific expression of a more general anxiety. I’ve never been to therapy. There are many things that have led me to consider it. But one of the most distinct, definable, and pressing has been my obsession with hair loss.
Hollywood has made movies about it. Industries have made billions from it. And if the volume of scripture is any indication, the Almighty God must have placed great value on his creation of the head of human hair. After all, He gave Samson—the strongest man of whom the Bible tells—his immense strength through his hair and declared a woman’s hair "a glory unto" her in the 11th chapter of 1 Chorinthians.
During a hair transplant procedure, a dermatologist or cosmetic surgeon removes tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. Some doctors recommend using minoxidil after the transplant, to help minimize hair loss. And you may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
I started combining two of them right away – because they both had different ingredients that I really wanted. I combine the Hair Surge for the caffeine, ketoconazole, and saw palmetto, along with the Regenepure DR for the Emu oil. I use a bit of both every day – and though I haven’t noticed a lot of hair coming back in – I HAVE noticed that a whole lot less is falling out. I used to see lots of hair in the tub or in my hand after drying. Hopefully some baby hairs will start so show themselves soon.
While not a cure for hair loss, this will clear up the muddy waters no doubt. DNA-testing is just starting to be commercially available and by 2020 you’ll be able to count on the likelihood that it will be much more advanced and affordable. Knowing for a fact at an early age whether or not someone will be predisposed to losing their hair will make a huge difference.  This will help that individual be able to plan, budget, and research their options before their hair even begins thinning.
Tinea capitis requires systemic treatment; topical antifungal agents do not penetrate hair follicles. If the causative agent is a Trichophyton species, treatment options include oral terbinafine (Lamisil), itraconazole (Sporanox), fluconazole (Diflucan), and griseofulvin.15 These agents have similar efficacy rates and potential adverse effects, but griseofulvin requires a longer treatment course. Griseofulvin is the preferred treatment for infections caused by Microsporum species, but definitive studies are lacking.15,16 There are limited data about empiric treatment before culture results are available. Because griseofulvin may have lower cure rates in the treatment of T. tonsurans infections, it may not be as effective when used empirically.15 All close contacts of patients with tinea capitis should be examined for signs of infection and treated, if necessary.
Beyond that, things get more controversial, with some doctors saying there's inadequate evidence for other treatments. Saxena thinks there is enough scientific evidence to support some of the alternatives and recommends them to patients. But they are not for women on tight budgets. There's Nutrafol, a "nutraceutical" that costs about $80 a month. Women can also get injections in the scalp of platelet-rich plasma made from their own blood. The first four treatments cost about $2,000 at Saxena's practice in Fort Washington or Lansdale. Maintenance injections, done every three to six months, cost $515 each. Women can also buy Theradome, a light-emitting helmet, for $895 online.  Saxena, who has hair loss herself, said she has had the injections and currently uses minoxidil, spironolactone, and Nutrafol.

The answer, to be brutally honest, is no. Combine that with the fact that many shampoo manufacturers are hungry for a quick buck and make false claims about ingredients that haven’t been proven to work, and you have a market that can be treacherous to navigate. There are even fake reviews – which is a whole additional layer of deceit when you think about it.


Follicle Thought is interested in connecting with scientists and startups who are working on hair growth or hair loss prevention research. If you or a colleague is working on hair growth please get in touch on the Contact page, even if you are not ready to share news on the site yet. Follicle Thought can offer networking and other resources to benefit your development. Thanks
Perhaps the most important area of hair loss research that I have not yet covered on this blog relates to the Sonic Hedgehog (SHH) protein and signaling pathway.  This Shh pathway is used by cells to communicate with each other. While the sonic hedgehog protein has numerous critical effects on a developing human embryo (brain, craniofacial, lungs, teeth and more), it also continues to be important in adulthood when it controls certain stem cell division activities.

This video is equally hilarious. Once again, there is inspiration here. Deion had a 5,000+ FUE last year and received good results from it. But he’s not done yet, he has the resources to have another procedure and get as close as he can to the result that he really wants, so he did. Surely, he’s just about maxing-out his donor area now. Once again, congratulations to Deion for pursuing his hair growth goals. Enjoy the video and have a big laugh. OOOOeeee.
If you’re a lady and can remember the one difference in directions (or just scope out the instructions online) we recommend saving the cash. Similarly, you could go generic with Equate Hair Regrowth Treatment for Men or Costco’s Kirkland Signature Hair Regrowth Treatment Minoxidil Foam for Men. These alternatives offer the same percentage of active minoxidil and near-identical inactive ingredients for as little as half the price — a great option for both genders.
Certainly a company with a unique background and game plan, HairClone has received some recent media attention. The UK biotech startup was featured in this month’s publication of “Consulting Room” online magazine. In the article both Dr. Bessam Farjo and Paul Kemp of HairClone provided insight as to the company’s current progress and plans for the future. Things seem to be coming along well for HairClone and we should expect to hear from them again within the next several weeks. Full story is on Articles main page.
Giovanni Mele, a stylist who owns Giovanni and Pileggi in Center City, said many women with thinning hair try to wear their hair long. He thinks they're much better off with short, pixie-like styles with light layering on top. He recommends that lighter-skinned women choose colors that are a little darker than blond or gray. He is a fan of a hair-thickening product made by Nioxin.
Female pattern baldness: Treatment and genetics While most women lose between 50 and 100 strands of hair per day, this hair is usually quickly replaced by new growth. When bald patches or thinning occurs, however, it may be a sign of female pattern baldness. In this article, learn more about the common causes and treatment of hair loss in women. Read now

In the operating room, Bernstein prepped the robot patient for implantation, puncturing the man’s scalp with a long needle. These are the “sites” where the hairs will go. Blood bubbled over his scalp, but the patient didn’t seem to notice. The patient and doctor chatted loosely about summer houses and beers and boats. “Would I be a candidate for a surgery after this surgery?” he asked.

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.”
One hard truth: Hair loss is mostly out of your control. “Baldness comes down to your genes,” says Frederick Joyce, M.D., founder of Rejuvenate! Med Spa and a member of the International Society for Hair Restoration Surgery. “If you have the baldness gene, there are some natural remedies that may make your hair stronger and healthier to slow your hair loss slightly—but they won’t prevent you from going bald. Still, maintaining hair health by eating well and using the right products—combined with medical-grade treatments—can really work all together to help you have a fuller, thicker head of hair.” 

Some treatments in development hold particular promise for women. Angela Christiano, a hair geneticist and Columbia University professor of dermatology, is hoping to begin clinical trials in a year or two on a procedure in which she dissects hair-follicle stem cells, grows them in the lab until she has several million, then injects them into the scalp, where, a very small study done with a human skin model has shown, they induce new hairs.
What's to know about alopecia areata? Alopecia areata is an autoimmune disorder that usually results in unpredictable, patchy hair loss. Approximately 7 million people in the U.S. have alopecia areata, and it can affect anyone of any age or gender. There is no cure for alopecia areata although some treatments are available to help hair regrow more quickly. Read now 

Hair loss is often distressing and can have a significant effect on the patient's quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist. Nonscarring alopecias can be readily diagnosed and treated in the family physician's office. Androgenetic alopecia can be diagnosed clinically and treated with minoxidil. Alopecia areata is diagnosed by typical patches of hair loss and is self-limited. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically. Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress. Once the precipitating cause is removed, the hair typically will regrow. Trichotillomania is an impulse-control disorder; treatment is aimed at controlling the underlying psychiatric condition. Trichorrhexis nodosa occurs when hairs break secondary to trauma and is often a result of hair styling or overuse of hair products. Anagen effluvium is the abnormal diffuse loss of hair during the growth phase caused by an event that impairs the mitotic activity of the hair follicle, most commonly chemotherapy. Physician support is especially important for patients in this situation.
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