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 Health & Beauty | April 2006 
Gone Today, Hair Tomorrow
 Eric D. Tytell - LATimes
| | A patient with a receding hairline before treatment. | 
| | After nine months of treatments, the patient sports a new patch of growth. The latest hair transplants are nearly undetectable, with surgeons generally moving a few thousand hairs in one session. (Ziering Medical) |
Oil of wormwood.
Dog urine.
Equal parts Abyssinian greyhound's heel, date blossoms and ass hoof, boiled in oil.
Being licked by a cow.
Through the centuries, men losing their hair have resorted to desperate measures to recover the luxurious tresses of their youth — but happily, their options have expanded substantially beyond dog urine. Now there are sophisticated transplant techniques and drugs shown by science to be more than mere snake oil.
And more is still to come. Higher-tech remedies are being cooked up in the clinic — ones that may solve the shortcomings of today's solutions, which for the most part just save hairs that already exist or move them around on the scalp.
Researchers are beginning to understand the biological nuts and bolts of why hair grows and stops growing. They're looking forward to the day when they can remove a few hairs, multiply them in a lab and completely fill in a bald spot — or slap on creams that can stop and start hair growth whenever and wherever they like.
"I think, ultimately, we will find a way to take a single follicle and clone it, to re-create it in a petri dish — and that solves all of our problems," says Dr. Claire Haycox, a clinical associate professor of medicine at the University of Washington in Seattle.
A deeper function
Hair serves no fundamental biological purpose. It doesn't keep us warm, pad our heads particularly well or shield us effectively from the sun. But prosaic mechanics can't encapsulate the huge role hair plays in the human psyche. From ancient times, hair has symbolized strength and beauty.
"Golden-haired Achilles" was the greatest warrior in Homer's "Iliad."
Samson's long hair made him invincible. "If I be shaven," he says in Judges 16:17, "then my strength will go from me, and I shall become weak, and be like any other man."
And in Shakespeare's "Merchant of Venice," Bassanio describes the hair of his love, Portia, as "A golden mesh to entrap the hearts of men/Faster than gnats in cobwebs."
Shakespeare and Homer understood a subtle biological truth: When we look for a mate, we unconsciously seek signals of that person's health, the better to produce robust offspring. A full head of lustrous hair, in man or woman, is a reliable sign of vigor and good nutrition — in evolutionary terms, of a better mate. So when hair starts disappearing, it's not surprising that the loss can be traumatic.
Typically, men start losing their hair in their 20s and 30s. Twelve percent of men have lost most of it before their 30th birthday. By age 50, more than half have developed a bald spot and receding hairline.
Most men try to shrug it off, says Dr. Craig Ziering, a cosmetic surgeon in Beverly Hills. After all, they're men — they don't want to think about their feelings, or heaven forbid, reveal them.
Ziering's patients tend to be ambitious businessmen, actors and celebrities. They're looking for a competitive edge and they worry that their hair loss works against them. "You go back to that hunter mentality," he says. "It's the competition for women or a job."
Once they take the step of seeking treatment, the relief, he says, is palpable.
Rick Juel, a fitness trainer and massage therapist in San Pedro, was surprised by his own reaction. "I told myself that if I went bald or thinned as I got older, it wouldn't matter to me — I would let life and age happen," he says. "But then, when it actually happens, you get a different take on it."
He'd flinch at the snapshots taken by his buddy during camping and scuba-diving vacations. "If he caught me with the camera the wrong way it would look like I was his father or something," he says. "Looking through the pictures, I'd say, 'Get rid of this old-man shot!' "
After a while, he thought: Why should he put up with this? "I always try to improve myself spiritually and mentally and physically. So I thought, why stop with that? Why not try to continue to grow, or continue to improve — even in my appearance?"
Cycles of the scalp
The cause of balding lies within the hair follicle, a microscopic pocket in the skin. Hair sprouts from this pocket, journeying through four distinct seasons — growth, regression, rest and shedding.
In the growth phase, the hair shaft lengthens. Then the follicle begins to shrink: the regression phase. Next comes rest: The remains of the follicle hang on to the dead hair. Finally, it sheds the old hair in preparation for growing a new one.
Hairs on the scalp may stay in the growth phase for years before moving through regression, rest and shedding, which is why hairs can grow so long. They grow, at least, until testosterone kicks in. Men appreciate most of testosterone's effects: the beard, bulging biceps, square manly jaw. The gleaming bald dome is less well-liked.
The ancient Greek physician Hippocrates noted the link between testosterone and hair loss: He observed that castrated men, who don't make the hormone, didn't go bald.
Then in the 1940s, anatomist James Hamilton proved the link by injecting castrated men with testosterone and observing that their hair — thick and full up to this point — began falling out.
Later studies showed that the true hair-loss culprit isn't testosterone but its byproduct known as DHT, which for some reason only affects the hairs on the top of the head, not those on the back. (Hence the "pattern" of male pattern baldness.)
The irony is that those shiny bald spots aren't actually bald. The hairs are still there, but instead of the thick, lush hair of shampoo advertisements, clear "peach fuzz" hairs are sprouting out of tiny, miniaturized follicles.
"I think of it as putting your hair follicle on a copier and hitting reduce," says Angela M. Christiano, a dermatology professor at Columbia University. "All of the machinery is still there — the hardware is intact; it's more of a software problem."
The FDA has approved two remedies for that software glitch.
Minoxidil (Rogaine), approved as a baldness treatment in 1988, was the first truly effective treatment in the long history of remedies for hair loss. It jump-starts the follicles, making them stop resting, shed the old hair, and start growing new hairs. No one knows why it works; it might have something to do with potassium regulation in the cells, says Dr. George Cotsarelis, associate professor of dermatology at the University of Pennsylvania School of Medicine.
Finasteride (Propecia), approved by the FDA in 1997, is better understood. It stops the formation of DHT in the scalp, blocking testosterone's hair-thinning effects.
Dermatological studies show that extra-strength Rogaine (5% minoxidil) thickens hair overall and even causes some regrowth in 60% of men after one year of use. Propecia stops hair loss over a five-year period in 90% of men and leads to 14% more hairs on average.
But there are limits to how much hair both drugs can save. And for someone who already has a large bald spot, 14% more hair may not be enough.
In fact, both of the drugs are best at maintaining existing hair. For the most part, they can't reverse the miniaturization of follicles that leads to bald spots.
"If you get regrowth, that's sort of a bonus," Cotsarelis says.
This is hardly the stuff of heady dreams.
Now, as scientists begin to understand the mechanics of the hair cycle itself, they're aiming for new drugs that could do just that — regrow hair.
Probably the most promising recent discovery has been that of the role of a gene called "sonic hedgehog" in hair growth. The gene (which is indeed named after the Sega video game) is known to be vital to the development of organ systems in embryos. In adults, one of the few "organs" that continues growing and relying on the gene is hair.
Curis Inc., a Cambridge, Mass.-based biotechnology company, is developing a drug based on this gene. The company has produced a small molecule that mimics the effects of sonic hedgehog and can penetrate the skin and home in on the follicle directly.
Last year, it presented findings at a meeting of the American Academy of Dermatology showing that the molecule causes mouse hair follicles to jump into action. First researchers shaved the mice, then they rubbed the molecule into the animals' skin. A thick patch of hair developed quickly — far faster than it would have naturally.
Curis teamed with Procter & Gamble Pharmaceuticals last September to start developing a drug for humans. It is applying to the FDA to start safety trials late this year or next year.
Although a drug based on sonic hedgehog could cause birth defects in embryos, the team is optimistic that their molecule should be safe when rubbed into the skin of adults, says Carmen Pepicelli, senior director of business development at Curis.
Until scientists learn how to jump-start sleeping follicles, the only solution is to move good follicles into the bald areas.
Hair transplantation was once a crude operation, taking big chunks of skin and hair and moving them around. "Even a pig farmer could do it," says Dr. Ronald Moy, clinical professor of dermatology at UCLA.
These days it has moved well beyond the artificial-looking "doll's hair" plugs that were used in the '80s.
Surgeons pull out a thin strip of skin and hair, usually from the back of the head (where hairs don't fall out in response to DHT), and dissect it under a microscope into follicular units — one or two hairs stuck together. Then they make tiny slits on the top of the scalp and slip the hairs in.
Generally, surgeons can move a thousand or a few thousand hairs in one session. Usually, they're trying to reconstruct the hairline and cover as much of the bald spot as they can, in as natural-looking a way as possible.
"In the past, there was a lot of waste and big plugs — it was obvious that people have had transplants," Ziering says. "Now we get very nice results. My best work goes unnoticed."
But surgeons can't make more hair. They can only move existing hairs around. "Sometimes we try to put the hairs in at an angle because it may cover more that way," Moy says.
An unlimited supply of hair would make all the difference.
Coaxing cell growth
In 1999, Colin Jahoda of Durham University in England made scientific headlines when he transplanted key cells from the follicle known as dermal papilla (DP) cells from his head to his wife's arm.
Soon enough, four new hairs sprouted.
It was, to be sure, an impressive party trick. But Jahoda's real aim was to show, first, that transplanted hair follicles wouldn't be rejected by the body like a transplanted heart. And, second, that these DP cells, on their own, were able to command the skin into which they were transplanted to grow an entire new follicle.
DP cells, just like hair, are in short supply on the scalp. But the dream is to remove a few hairs from someone's head, tease out the DP cells, let them multiply many times in a dish in the lab, then inject them back into the same person's bald spot, where they would cause many new hairs to grow.
Until recently, no one knew how to do that. Scientists could grow DP cells in a lab, but the cells lost their ability to induce new hair growth.
The key was "to find the 11 secret herbs and spices to let the cells multiply while still keeping the ability to grow hair," says Dr. Ken Washenik, executive vice president of Aderans Research Institute (ARI), based in Atlanta and Philadelphia.
Now two companies say they have done it: ARI and Intercytex, a biotechnology firm based in Manchester, England. These days, says Nick Higgins, chief executive of Intercytex, scientists can multiply the number of cells about a thousandfold.
ARI has been testing the cells in petri dishes using donated human skin left over from cosmetic surgery. It has shown that the cultured DP cells will grow nice, dark, pigmented hair, the kind you normally think of on the top of the scalp.
"We're growing human hair, and we're growing it on human skin," Washenik says proudly.
Intercytex, meanwhile, has started testing its cells on human heads. Last year, it conducted a clinical trial mostly to ensure the procedure was safe.
First, hair follicles were taken from the backs of the heads of seven balding men. Then the DP cells were dissected and grown in the lab in dishes.
Intercytex then went back to the same men and injected each man's DP cells back into his bald spot, just below the surface of the skin. It did about 100 injections per person in a half-inch-square area. "In five out of seven we got increased hair growth," Higgins says.
The long search for baldness cures may be drawing to a close, but for now, myths about hair loss still abound. People are still rubbing herbs and chemicals into their bald heads, hoping that something will work.
They're not using dog urine anymore. But today special shampoos with herbs and vitamins probably are about as useful.
Or less useful.
Urine, pigeon droppings and other skin irritants can cause transient hair growth, in the same way that hair tends to grow underneath a plaster cast.
Even being licked by a cow might be beneficial. Cow saliva contains epidermal growth factor, which can stimulate cells in the follicle to make hair more quickly.
As surgeons start to mass-produce hairs in dishes and dermatologists scribble out prescriptions for potent, hair-growing salves, the era of folk remedies — of laser combs, oil of wormwood and herbal shampoos — may finally end.
No one will need cow saliva anymore, except the cow.
Did you know that...
• The longest hair on record belongs to Xie Qiuping of China, according to the Guinness Book of World Records. It measured 18 feet, 5.54 inches on May 8, 2004.
• Hair typically grows at about 0.5 inches a month, making it the second fastest growing tissue in the body after bone marrow.
• At any one time, 90% of scalp hairs are actively growing, while 10% are resting.
• People normally lose around 100 hairs a day.
• Cutting hair does not change its growth rate.
• The average scalp has 100,000 hairs. Blonds typically have the most hairs, while redheads have the fewest.
• Everyone is born with as many hair follicles as they will ever have. Follicles may change the type of hair they produce, but their number doesn't typically change.
• Hair varies in thickness from about 1.5 to 5 thousandths of an inch, or from about half to twice as thick as a piece of paper.
• Hair is about as strong as a copper wire of the same thickness.
• Body hair and pubic hair stay shorter than head hair because the growth phase of hairs in these regions is much briefer.
• Hair follicles usually cycle through growth and shedding randomly, so that you're never losing large amounts of hair all at once.
• Sometimes follicles synchronize, releasing their hairs all at the same time, a condition called "telogen effluvium." This is what happens when cats and dogs shed in the springtime.
• Synchronized shedding can happen in humans after a physically traumatic event — or two to three months after pregnancy.
• Male pattern hair loss is inherited from both sides of the family.
• One of the most famous snake oil hair remedies was sold in the late 19th century by the Seven Sutherland Sisters, who were reported to have 37 feet of hair among them.
• Scientists suspect that men lose hair from the top of their heads because skin cells in that region originate from a different part of the embryo and are biologically different.
• The hair-restoring properties of minoxidil (Rogaine) were discovered by accident in the 1970s. Patients taking the drug for high blood pressure sprouted hair on their arms, legs, backs, cheeks and foreheads.
• Finasteride (Propecia) was developed after scientists observed that people genetically unable to make the male hormone DHT never lost their hair.
Types of Hair Loss: Although male pattern baldness is by far the most well-known type of hair loss, various other types exist. Here are some, and their causes.
Name: Male pattern hair loss (androgenetic alopecia)
Whom it affects: Men
Pattern: Balding on crown and temporal regions of the scalp
Origins: Hair follicles sensitive to DHT in scalp
Remedies: Minoxidil, finasteride, hair transplantation
Name: Female pattern hair loss (also referred to as androgenetic alopecia)
Whom it affects: Women, particularly after menopause
Pattern: Diffuse thinning all over the scalp
Origins: Unknown; possibly DHT-related
Remedies: Minoxidil, hair transplantation
Name: Chemotherapy-induced alopecia
Whom it affects: Cancer patients
Pattern: Varies depending on chemotherapy drug
Origins: Chemotherapy drugs attack hair follicles
Remedies: Scalp cooling; hair regrows after end of chemotherapy
Name: Alopecia areata
Whom it affects: Anyone, including children
Pattern: From patchy bald spots to complete loss of hair
Origins: Autoimmune disorder
Remedies: Cortisone, minoxidil; hair often regrows naturally
Name: Telogen effluvium
Whom it affects: Anyone after physically traumatic events, particularly women post-childbirth
Pattern: Synchronized shedding of large amounts of hair
Origins: Physical stress or nutrient deficiency causes hair follicles to release hair shaft
Remedies: Hair usually regrows naturally, but condition can become chronic
Name: Traction alopecia; central centrifugal cicatricial alopecia
Whom it affects: Primarily African American women
Pattern: Scarring and hair loss on crown of the scalp
Origins: Chemical or thermal hair straightening; tightly gathered hair styles such as cornrows
Remedies: Change of hair style or hair transplantation
Source: Reported by Eric D. Tytell |
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