Androgenetic alopecia from A to Z. Volume 2, Drugs, herbs, nutrition and supplements

This second of three related volumes, designed as a reference tool for the understanding and treatment of Androgenetic Alopecia and Female Pattern Hair Loss (AGA/FPHL), is structured in 4 sections: 63 dedicated chapters covering every aspect of medical (non-surgical, non-invasive) and nutritional treatment options and clinical effects. FDA-approved hair growth drugs, every frequently prescribed "off-label" or experimental drug, hormones, cosmeceuticals, and popular fraudulent controversial products are all presented in 26 chapters, with figures, tables, algorithms, and thousands of fully updated and balanced literature citations. Filling a gap in the latest literature, Androgenetic Alopecia From A to Z: Drugs, Herbs, Nutrition, and Supplements includes a thorough review of lifestyle and nutritional factors specifically affecting AGA/FPHL, including excessive caloric intake, high-fat diets, caloric deprivation, alcohol abuse, and smoking. The intricate effects of nutrition on hair loss, one of the most neglected and misunderstood fields in Dermatology, are presented as well, with a plethora of clinically valuable information: why food supplements are so popular, the regulatory minefield of supplements, and the life-threatening perils of nutritional supplementation, are all reviewed extensively. Each vitamin, major mineral, and trace element implicated in follicular physiology is reviewed in altogether 24 dedicated chapters according to their specific effects on the hair follicle, food sources, dietary recommendations, and the impact of deficiency or excess. This volume includes a comprehensive chapter on the understanding of Complementary-Alternative Medicine (CAM). CAM is an umbrella term for methods that lie outside evidence-based medicine and a part of a societal trend towards the rejection of science as a method of determining facts. The pitfalls and challenges in understanding botanicals with reported hair growth properties, from publication bias to lack of standardization, as well as their unpredictable pharmacological and physiological effects, are all explained in detail. Finally, all popular botanical products reported to possess hair growth properties are appraised in 14 dedicated chapters, each including a detailed review of the general effects, the suggested biochemical mechanisms, claimed actions on the hair follicle, all available studies, and hundreds of literature citations. This carefully crafted book will be an invaluable reference tool for dermatologists and all clinical practitioners dealing with Androgenetic Alopecia and Female Pattern Hair Loss and will help them answer challenging patient questions, debunk myths on hair growth drugs, and supplements and navigate patients towards effective and safe treatment schemes. Foreword Foreword Preface Acknowledgments Contents Part V: Drugs A Patient’s “Odyssey” What Hair Loss Patients Expect from a Physician Classification of Hair-Growth Medications What to Expect from Medical Treatment? Medical Treatments and Online Advice The “Hair Loss Forum Habitat” Basic Principles of Pharmaceutical Treatment in AGA/FPHL Beyond Evidence-Based Medicine 23: Minoxidil 23.1 Initial Studies and FDA Approval 23.2 Mechanism of Action 23.3 Minoxidil Effects and Clinical Results 23.4 Minoxidil Topical Solution and Early Research 23.5 Minoxidil and FPHL 23.6 Ideal Candidates for Minoxidil 23.6.1 Is Minoxidil Effective Only on the Vertex? 23.7 Efficacy of Minoxidil 23.7.1 How Soon Will Minoxidil Grow Hair? 23.7.2 Minoxidil Discontinuation and Effects 23.8 How to Use MTS/MTF Properly 23.9 Adverse Effects 23.9.1 Systemic Adverse Effects 23.9.2 Local Adverse Effects 23.9.2.1 Propylene Glycol 23.9.2.2 Ethanol 23.9.3 Ectopic Hypertrichosis 23.10 Minoxidil and Daily Practice 23.11 Minoxidil Topical Foam 23.12 Novel Minoxidil Formulations 23.13 Oral Minoxidil 23.14 A Final Note by the Author References 24: Finasteride 24.1 Finasteride in BPH 24.2 Finasteride in AGA 24.3 Mechanism of Action of Finasteride 24.3.1 Does Finasteride Act in Any Other Way? 24.4 Clinical Studies on Finasteride 24.5 Clinical Efficacy of Finasteride 1 mg 24.6 Metabolism of Finasteride 24.7 Adverse Effects of Finasteride 24.7.1 Finasteride 5 mg and Sexual Adverse Experiences (SAEs) 24.7.2 Finasteride 1 mg and SAEs 24.7.3 The Nocebo Effect! 24.7.4 Are SAEs Reversible? 24.7.5 Post-Finasteride Syndrome (PFS) 24.7.6 Can Persistent SAEs Be Explained? 24.7.7 Finasteride Effects on Fertility 24.7.8 Finasteride Effects on PSA 24.7.9 Finasteride and Prostate Cancer (PCa) 24.7.10 Finasteride, Gynecomastia and Breast Cancer 24.7.11 Finasteride, Depression and CNS Effects 24.8 Topical Use of Finasteride 24.9 Finasteride Vs. Minoxidil 24.10 How to Best Combine Finasteride and MTS 24.11 Finasteride and FPHL 24.12 Final Notes References 25: Dutasteride 25.1 Mechanism of Action and Pharmacodynamics 25.2 Pharmacokinetics of Dutasteride 25.3 Dutasteride in BPH 25.4 Dutasteride and ΑGΑ 25.5 Dutasteride and FPHL 25.5.1 Dutasteride and Prostate Cancer (PCa) 25.5.2 Dutasteride, Gynecomastia and Breast Cancer 25.5.3 Dutasteride and Sexual Adverse Experiences (SAEs) 25.5.4 Dutasteride and Fertility 25.5.5 Dutasteride, Depression and CNS Effects 25.6 Topical Use of Dutasteride 25.6.1 Intralesional Dutasteride and Mesotherapy 25.7 Dutasteride + Finasteride, Dutasteride + Minoxidil 25.8 Concerns Over the Use of Dutasteride in AGA 25.9 Conclusion References 26: Spironolactone 26.1 Mechanism of Action 26.2 Spironolactone as an Antiandrogen 26.3 Spironolactone and FPHL 26.4 Topical Spironolactone 26.5 Adverse Effects References 27: Cimetidine 27.1 Mechanism of Action 27.2 Use of Cimetidine 27.3 Cimetidine and ΑGΑ/FPHL 27.4 Adverse Effects References 28: Cyclosporin 28.1 Mechanism of Action on the Hair Follicle 28.2 Cyclosporin A in Alopecia Areata 28.3 Cyclosporin A in AGA/FPHL 28.4 Adverse Effects References 29: Cyproterone Acetate (CPA) 29.1 Mechanism of Action 29.2 Uses of CPA 29.3 CPA and FPHL 29.4 Topical CPA Solution 29.5 Adverse Effects 29.6 CPA in Men References 30: Topical Corticosteroids 30.1 The Chemical Structure of Corticosteroids 30.2 Topical Corticosteroids (TCs) 30.3 Actions of Corticosteroids 30.4 Adverse Effects of TCs 30.5 Systemic Adverse Effects of TCs 30.6 Topical Adverse Effects of TCs 30.7 TCs and Alopecia Areata 30.8 TCs and AGA/FPHL References 31: Ketoconazole 31.1 Pharmacology of Ketoconazole 31.2 Oral Ketoconazole 31.3 Ketoconazole Shampoo 31.4 Ketoconazole and ΑGΑ/FPHL 31.5 How to Use the Ketoconazole Shampoo 31.6 Adverse Effects References 32: Retinoic Acid 32.1 Mechanism of Action of Retinoids and ATRA 32.2 ATRA and the Hair Follicle 32.3 ATRA and AGA/FPHL 32.3.1 Use of ATRA in AGA/FPHL 32.4 Adverse Effects 32.5 Combining ATRA and Minoxidil 32.6 New Pharmaceutical Formulations of ATRA and Newer Retinoids References 33: Azelaic Acid 33.1 Mechanism of Action 33.2 Azelaic Acid and AGA/FPHL 33.3 Adverse Effects References 34: Bimatoprost 34.1 Mechanism of Action 34.2 Bimatoprost and Hair Follicles 34.3 Bimatoprost Mechanism of Action on Hair Follicles 34.4 Effect of Bimatoprost in Healthy Eyelashes 34.5 Bimatoprost Vs. Latanoprost 34.6 Bimatoprost and AGA/FPHL 34.7 Adverse Effects References 35: Latanoprost 35.1 Latanoprost and Hair Follicles 35.1.1 Latanoprost Mechanism of Action on Hair Follicles 35.2 Effects of Latanoprost in Eyelashes 35.2.1 Latanoprost and Healthy Eyelashes 35.2.2 Latanoprost and Eyelash Alopecia 35.3 Effects of Latanoprost on The Scalp References 36: Estrogens 36.1 Mechanism of Action of Estrogens 36.2 Estrogens and Hair Follicles in Lab Animals 36.3 Estrogens and Hair Follicles in Humans 36.4 Estrogens, AGA and FPHL 36.4.1 Oral Estrogens 36.4.2 Topical Estrogens 36.4.2.1 Topical Estrogens in Men 36.4.2.2 Topical Estrogens in Women 36.5 Adverse Effects References 37: Progestins 37.1 Categories of Progestins 37.2 Mechanism of Action 37.3 Actions in the Skin and Hair Follicles 37.4 Topical Progestin Solutions 37.5 Progestins and AGA/FPHL 37.6 Adverse Effects References 38: Hormonal Contraceptives 38.1 General Hormonal Effects of OCs 38.2 Hormonal Effects of OCs in Hair Follicles 38.3 Clinical Image 38.4 How to Avoid OCs-Mediated Hair Loss? 38.5 COCs as a Treatment for FPHL References 39: Flutamide 39.1 Mechanism of Action 39.2 Flutamide and Hair Follicles 39.3 Topical Use of Flutamide 39.4 Adverse Effects References 40: Recently Reported Hair Growth Drugs 40.1 Adenosine 40.2 Cetirizine 40.3 Roxithromycin 40.4 Botulinum Toxin 40.5 Crescina References 41: Caffeine 41.1 Caffeine in Dermatology 41.2 Caffeine and the Hair Follicles 41.3 Caffeine and AGA/FPHL 41.4 Conclusion References 42: Cysteine and Cystine 42.1 Sources of Cysteine 42.2 Cystine/Cysteine Dietary Supplements 42.3 Cystine and the Hair Follicle References 43: Free Fatty Acids 43.1 Free Fatty Acids (FFAs) 43.2 FFAs, Hair Follicles, AGA and FPHL References 44: Copper Tripeptides 44.1 Mechanism of Action and Properties of GHK-Cu 44.2 GHK-Cu and Hair Follicles 44.3 Clinical Studies 44.4 GHK-Cu and in Hair Restoration Surgery References 45: Melatonin 45.1 The Effects of Melatonin in the Hair Follicles of Animals 45.2 The Effects of Melatonin in Human Hair Follicles References 46: Marine Extract Compounds 46.1 Nourkrin® 46.2 Hairgain® 46.3 Viviscal® 46.3.1 Viviscal® in the Twenty-First Century References 47: The Helsinki Formula®: Polysorbate 60 and Polysorbate 80 47.1 Polysorbate 60 and Hair Follicles 47.2 Polysorbate 60 and the Hair Growth Craze 47.3 Was Polysorbate 60 Effective Against Hair Loss? 47.4 What Happened with Polysorbate 60 Products? 47.5 Adverse Effects References Part VI: Nutrition, Lifestyle Factors and AGA/FPHL 48: Diet, Lifestyle, and AGA/FPHL 48.1 Are Systemic Androgens Increased in AGA/FPHL? 48.2 Adrenal Hormones and Androgens 48.2.1 What Can Cause Chronically Increased Cortisol Secretion in Otherwise Healthy Adults? 48.2.1.1 Stress 48.2.1.2 Obesity 48.2.2 Other Factors that Increase Androgens in the Serum 48.2.3 High-Fat Diets and Androgens 48.2.4 Deprivation (Crash) Diets and Androgens 48.2.5 Alcohol Abuse and Androgens 48.2.6 Smoking 48.2.6.1 Smoking and Androgens 48.2.6.2 Smoking, Hair Follicles, and AGA 48.3 Tips That Could Reduce Further Hair Loss in AGA/FPHL References Part VII: Dietary Supplements and Androgenetic Alopecia How Was Initially Hair Loss Correlated with Malnutrition? An Outrageous Misconception! Is There Hair Loss Due to Nutritional Disorders? Nutritional Disorder-Related Hair Loss with Scaling Problems Nutritional Disorder-Related Hair Loss Without Scaling Problems Hair Loss Without Nutritional Disorders History of Dietary Standards Adequacy of Nutrients 49: The Inconvenient Truth About Food Supplements (or “Hope in a Capsule”) 49.1 Why Are These Products So Popular? 49.2 Regulatory Issues 49.3 Who Is Using Food Supplements? 49.4 Who Really Needs Food Supplements? 49.5 Group ...Therapy 49.6 Can Food Supplements Be Dangerous? 49.7 Supplements That Can Eventually Kill 49.8 Questions Nobody Seems to Ask References 50: Vitamins: Definition and Types 50.1 Vitamins in General References 51: Vit A 51.1 Actions of Vit A 51.2 Vit A and the Hair Follicle 51.3 Food Sources 51.4 Dietary Recommendations 51.5 Deficiency- Excess of Vit A 51.6 Topical Use of Vit A References 52: Vit Β3 (Niacin) 52.1 Actions of Vit B3 52.2 Vit B3 and the Hair Follicle 52.3 Food Sources 52.4 Dietary Recommendations 52.5 Deficiency- Excess of Vit B3 References 53: Vit B5 (Pantothenic Acid) 53.1 Actions of Vit B5 53.2 Vit B5 and the Hair Follicle 53.3 Food Sources 53.4 Dietary Recommendations 53.5 Deficiency- Excess of Vit B5 References 54: Vit B6 (Pyridoxine) 54.1 Actions of Vit B6 54.2 Vit B6 and the Hair Follicle 54.3 Food Sources 54.3.1 Dietary Recommendations 54.3.2 Deficiency- Excess of Vit B6 References 55: Vit B7 (Vit H, Biotin, Coenzyme R) 55.1 Actions of Biotin 55.2 Biotin and the Hair Follicle 55.3 Food Sources 55.4 Dietary Recommendations 55.5 Deficiency- Excess of Biotin References 56: Vit C (L-Ascorbic Acid) 56.1 Actions of Vit C 56.2 Food Sources 56.3 Dietary Recommendations 56.4 Vit C Deficiency 56.5 Vit C Excess 56.6 Vit C and Hair Follicles In Vitro 56.7 Topical Action of Vit C References 57: Vit E (α-Tocopherol) 57.1 Actions of Vit Ε 57.2 Topical Action of Vit E 57.3 Vit E and the Hair Follicle 57.4 Food Sources 57.5 Dietary Recommendations 57.6 Deficiency- Excess of Vit E References 58: Inositol (Vitamin B8) 58.1 Actions of Inositol 58.2 Inositol and the Hair Follicle 58.3 Food Sources 58.4 Dietary Recommendations 58.5 Deficiency- Excess of Inositol References 59: Minerals, Trace Elements, and Hair Follicles 60: Calcium (Ca+2) 60.1 Actions of Ca+2 60.2 Ca+2 and the Hair Follicle 60.3 Dietary Recommendations 60.4 Food Sources 60.5 Deficiency- Excess of Ca+2 60.5.1 Hypocalcemia 60.5.2 Hypercalcemia References 61: Boron (B) 61.1 Actions of Boron 61.2 Boron and the Hair Follicle 61.3 Food Sources 61.4 Dietary Recommendations 61.5 Deficiency- Excess of Boron References 62: Sulfur (S) 62.1 Actions of Sulfur 62.2 Sulfur, the Skin, and the Hair Follicle 62.3 Food Sources 62.4 Dietary Recommendations 62.5 Deficiency- Excess of Sulfur References 63: Iodine (I) 63.1 Actions of Iodine 63.2 Thyroid Hormones and the Hair Follicle 63.3 Food Sources 63.4 Dietary Recommendations 63.5 Deficiency- Excess of Iodine References 64: Magnesium (Mg+2) 64.1 Actions of Magnesium 64.2 Mg+2 and the Hair Follicle 64.3 Food Sources 64.4 Dietary Recommendations 64.5 Deficiency- Excess of Magnesium References 65: Silicon (Si) 65.1 Actions of Silicon 65.2 Silicon, the Skin and the Hair Follicle 65.3 Food Sources 65.4 Dietary Recommendations 65.5 Deficiency- Excess of Silicon References 66: Selenium (Se) 66.1 Actions of Selenium 66.2 Selenium and the Hair Follicle 66.3 Food Sources 66.4 Dietary Recommendations 66.5 Deficiency- Excess of Selenium References 67: Iron (Fe+2) 67.1 Actions of Iron 67.2 Iron Distribution 67.3 Iron Deficiency (ID) 67.4 How Can Iron Deficiency Affect Hair Follicles? 67.5 Iron and Hair loss in General 67.6 Association Between Iron Deficiency, Ferritin and Hair Loss 67.7 Iron and AGA/FPHL 67.8 Topical Iron 67.9 Food Sources 67.10 Dietary Recommendations 67.11 Deficiency- Excess of Iron 67.12 Future Challenges 67.13 Conclusions So Far 67.14 Author’s Notes References 68: Copper (Cu) 68.1 Actions of Copper 68.2 Copper and the Hair Follicle 68.3 Food Sources 68.4 Dietary Recommendations 68.5 Deficiency- Excess of Copper References 69: Zinc (Zn) 69.1 Actions of Zinc 69.2 Zinc and the Hair Follicle 69.3 Zinc and Alopecias 69.4 Zinc and AGA/FPHL 69.4.1 Topical Use of Zinc 69.5 Food Sources 69.6 Dietary Recommendations 69.7 Deficiency- Excess of Zinc References 70: “Alternative Medicine”, Herbs, and Hair Loss 70.1 Herbals and Botanicals in General 70.2 Medicine and “Alternative Medicine” 70.3 Medicine and Herbal ...“Medicine” 70.4 Why Do Patients Prefer Herbs Over Drugs? 70.5 Just How Effective Are Herbs Actually? 70.6 Challenges in Studying the Efficacy of Herbs 70.7 Are Herbal Supplements Actually Safe? 70.8 The Legal Status of Herbals and Botanicals 70.9 Standardization of Herbs 70.10 Why is Herbal Standardization Impossible? 70.11 Herbs and Benign Prostate Hypertrophy (BPH) 70.12 Herbs for BPH = Herbs for AGA? 70.13 Herbal Products and ΑGΑ/FPHL 70.14 “Instructions for Use” of the Following Chapters 70.15 Final Note References 71: Saw Palmetto (Serenoa repens Sabal serrulatum) 71.1 Saw Palmetto Mechanism of Action 71.2 Saw Palmetto and Lower Urinary Tract Symptoms 71.3 The Saw Palmetto Controversy 71.4 Saw Palmetto and ΑGΑ 71.4.1 Is SPE a True 5α-R Inhibitor? 71.4.2 Can Saw Palmetto Be Useful in AGA/FPHL? 71.5 Dosage- Adverse Effects—Safety References 72: Pygeum Africanum (Prunus Africana) 72.1 Pygeum Africanum’s Mechanism of Action 72.2 Pygeum Africanum, BPH, and Prostate Cancer 72.3 Pygeum Africanum and AGA 72.4 Dosage- Adverse Effects—Safety References 73: Proanthocyanidins 73.1 Proanthocyanidins and the Hair Follicle. 73.2 Mechanism of Action of Proanthocyanidins on the Hair Follicle 73.3 Proanthocyanidins and AGA 73.4 Dosage- Adverse Effects—Safety References 74: Green Tea (Camellia sinensis) 74.1 General Properties of Green Tea 74.2 Green Tea and the Skin 74.3 Green Tea as an Antiandrogen 74.4 Green Tea and the Hair Follicle 74.5 Dosage- Adverse Effects—Safety References 75: Ginkgo Biloba (Maidenhair Tree) 75.1 General Properties of Ginkgo Biloba 75.2 Ginkgo Biloba, Scientific Research and Applications 75.3 Ginkgo Biloba, the Skin, and the Hair Follicle 75.4 Dosage- Adverse Effects—Safety References 76: Allium Cepa (Red Onion) 76.1 General Properties of Allium Cepa 76.2 Allium Cepa, Hair Follicles and AGA/ FPHL 76.3 Dosage- Adverse Effects—Safety References 77: Sophora Flavescens 77.1 General Properties of Sophora Flavescens 77.2 Sophora Flavescens and ΑGΑ 77.3 Dosage- Adverse Effects—Safety References 78: Oryza Sativa Bran (Rice Bran) 78.1 General Properties of Oryza Sativa Bran 78.2 Oryza Sativa Bran and Hair Follicles 78.3 Oryza Sativa Bran and AGA 78.4 Dosage- Adverse Effects—Safety References 79: Polygonum Multiflorum (Ho-Shou-Wu) 79.1 General Properties of Polygonum Multiflorum 79.2 Polygonum Multiflorum and the Hair Follicle 79.3 Dosage- Adverse Effects—Safety References 80: Panax Ginseng (Korean or Asian Ginseng) 80.1 General Properties of Ginseng 80.2 Ginseng and the Hair Follicle 80.2.1 PG Effects In Vitro and Ex Vivo 80.2.2 PG Effects in Clinical Trials 80.3 Dosage- Adverse Effects—Safety References 81: Rosemary (Rosmarinus Officinalis) 81.1 General Properties of Rosmarinus Officinalis 81.2 The Action of Rosmarinus Officinalis on the Hair Follicle 81.3 Rosmarinus Officinalis and AGA/FPHL 81.4 Dosage- Adverse Effects—Safety References 82: Capsicum (Red Pepper) 82.1 General Properties of Capsaicin 82.2 Mechanism of Action of Capsaicin 82.3 Action of Capsaicin on the Hair Follicle 82.4 Dosage- Adverse Effects—Safety References 83: A Few More and Recently Reported Herbs 83.1 Acanthopanax Koreanum 83.2 Asiasari Radix (Asiasarum Root) 83.3 Chaemacyparis Obtuse (Japanese Cypress, Hinoki) 83.4 Citrullus Colocynthis (Bitter Cucumber) (9- 83.5 Curcuma Aeruginosa 83.6 Cuscuta Reflexa 83.7 Ecklonia Cava 83.8 Eclipta Alba (False Daisy) 83.9 Erica Multiflora 83.10 Equisetum Arvense (Horsetail) 83.11 Hibiscus Rosa-Sinensis (China Rose) 83.12 Illicium Anisatum (Japanese Star Anise) 83.13 Lygodii Spora 83.14 Piper Nigrum (Black Pepper) 83.15 Puerariae Flos 83.16 Salvia Officinalis (Sage) 83.17 Sanguisorba Officinalis 83.18 Schisandra Nigra 83.19 T-Flavanone 83.20 Tectona Grandis (Teak Tree) 83.21 Trigonella Foenum-Graecum (Fenugreek) 83.22 Urtica Dioica (Stinging Nettle) 83.23 Zizyphus Jujube (Chinese Date) References Index