UNDERSTANDING HAIR LOSS
Here at Dynamic Regenerative Medicine at our hair loss clinic in Birmingham, we have been treating in the field of hair restoration for many years and have provided very high levels of success using the best treatment modalities and utilising the most up-to-date scientific research. Our specialist treatments consist of effective hair loss treatments used in regenerative medicine like platelet rich plasma (PRP), autologous micrografting cell transplant and dutasteride mesotherapy.
Platelet-rich plasma (PRP) is a very popular biological treatment, consisting of a portion of its own plasma with a very high concentration of platelets. It is these platelets that are very specialised cells that are highly enriched with several important growth factors, and many other plasma proteins, crucial in tissue repair and regeneration.
There are more than 20 bioactive growth factors in PRP which bind to cell surface receptors and activate cell signalling pathways, resulting in increased stimulation of new healthy tissue. Here we aim to highlight the causes of hair loss and the efficacy and benefits of specialist regenerative treatments like autologous micrografting and PRP in the treatment of hair loss (androgenic alopecia, pattern baldness) and alopecia areata (AA).
It is now very well established that PRP treatment is a very successful treatment of hair loss, specifically hair folliculogenesis (hair follicle stimulation) and hair cycling. Growth factors bind to receptors of hair follicles to activate the various biological pathways, needed for hair growth success. Furthermore, many of these growth factors such as VEGF, EGF, hepatocyte growth factor, fibroblast growth factor, and IGF-1, have angiogenic (new blood vessel) potential and can increase blood vessels around hair follicles, ultimately providing more life nutrition. Our hair loss treatment in Birmingham and Solihull has consisted primarily of regenerative treatments to stimulate hair follicles biologically, along with complementary treatments like minoxidil and finasteride.
So where is the evidence..?
Just in 2019 alone, 19 articles were published with the majority concluding that PRP is beneficial for hair preservation, thickness and regrowth. Please follow the link.
In addition to normal preservation and stimulation of hair follicles, the effect of PRP therapy on the hair follicular units in hair transplant surgery has also been observed. A significant improvement over conventional techniques is continuously reported. The study below looked at observing the effect of PRP treatment versus saline solution in the preservation of hair follicles prior to hair transplant surgery. It identified that preserving hair grafts in PRP before implantation increases the hair density, graft uptake, and the hair thickness compared with pre-treatment preservation of hair grafts in saline (study). A 2017 hair transplant surgical study looked at the effectiveness of PRP injections both during and after hair transplant surgery. It went on to report that PRP can act as a biological stimulus for transplanted hair. It found that PRP treatments stimulated blood supply around the treated area, which is thought to greatly benefit the success of a hair transplant (study).
An older 2006 found that scalps treated with PRP following on from hair transplant surgery had better stimulation of new hair growth. Some patients experienced a huge 52 per cent increase in hair density (study) A 2016 study by the Journal of cutaneous and aesthetic surgery reported that intra-operative PRP therapy is beneficial in giving faster density, reducing the catagen loss of transplanted hair, recovering the skin faster and activating dormant follicles in FUE transplant subjects (study).
6 trials were also reviewed on the efficacy of PRP injection treatment for androgenetic alopecia (pattern baldness) treatment. It was reported that PRP showed a higher level of improvement in hair thickness and overall clinical improvement than many other treatments. Excitingly, hair analyses post-treatment has identified that new hair has regrown from active (dormant) follicles. PRP treatment for hair loss has been shown in many cases to stimulate follicle regrowth and modulation of the hair cycle. The expression of these allows stem cells to have an active capacity and the ability to induce tissue with new blood supplies for hair cells to regenerate hair follicles. Stem cells also exert immuno-modulatory effects via direct cell interaction. Thus, irrespective of whether PRP is administered alone or in combination with other agents, it is very promising for the treatment of hair loss, and clinical practice is continuing to show ongoing success.
WHAT ARE THE CAUSES OF HAIR LOSS?
There are many things that contribute towards hair loss. Some of the common causes are listed below:
Post-pregnancy - due to a reduction of oestrogen
Nutritional deficiency - example vitamin D or vitamin B12
Birth control pills
TESTOSTERONE AND OESTROGEN ASSOCIATED HAIR LOSS
There are different types of testosterone. Dihydrotestosterone (DHT) is derived from testosterone and is made by an enzyme. This hormone is found in the skin, hair and prostate, and varies from men to woman. DHT binds itself to certain hair follicles and can cause them to reduce, resulting in the thinning of hair.
Both low and high levels of testosterone can result in hair loss. We need to understand that those with low testosterone levels may have the same amount of DHT that contributes to hair loss. Some people have the same amount of DHT as others, but their hair follicles are genetically programmed to be more sensitive to DHT. In androgenetic alopecia, men and women have been linked to fluctuating testosterone levels and genetics. It occurs in a specific pattern that may eventually result in complete balding.
Female pattern baldness usually affects women post-menopause as their androgen levels tend to rise and oestrogen levels drop. Researchers also tend to link genetics with this form of balding. Oestrogen increases the growth phase of hair. Oestrogen does decline post-menopause which affects hair. Also, the androgenic effects of testosterone can be intensified post-menopause.
Contraception and hair loss
Some birth control pills can slow or stop this thinning process because they increase your oestrogen levels and/or diminish your testosterone levels. Others can raise your levels of androgens (male hormones). These pills may trigger or worsen hair thinning. Generally speaking, in normal cases, a rise in oestrogen causes a mature egg to leave the ovaries during ovulation (menstrual cycle). Birth control pills stop the surge in estrogen that causes an egg to be released. Moreover, some birth-control pills are painful to increase the sensitivity of hair follicles.
Polycystic ovarian syndrome and hair loss
Ppolycystic ovarian syndrome is a common female hormonal disorder that can cause a range of symptoms, including increased facial and body hair. It is also associated with hair thinning and hair loss, which is referred to as female pattern hair loss. The female body produces male hormones, also called androgens, which include testosterone. Androgens play a role in triggering puberty, as well as having other important functions. Polycystic ovarian syndrome causes extra androgen production. contraceptive birth control pills are associated with reducing androgens.
HOW CAN HAIR LOSS BE TREATED?
Regenerative medicine in the effective treatment of hair loss
DHT & NEO-ANGIOGENESIS
Neoangiogensis is the key biological influence in any form of treatment in regenerative medicine. This often involves the use of biological cells like platelets and stem cells to facilitate the repair and promote new tissue regrowth. It does this via the means of bioactive protein growth factors and angiogenesis. Angiogenesis is the formation of new blood vessels. Neo–angiogenesis is the revascularisation of new tissue.
Neoangiogensis is the key biological influence in any form of treatment in regenerative medicine. This often involves the use of biological cells like platelets and stem cells to facilitate repair and promote new tissue regrowth. It does this via the means of bioactive protein growth factors and angiogenesis.
The hair follicle undergoes consistent cyclic expansion and regression, leading to rapidly changing demands for its vascular support. The below study aimed to quantify the cyclic changes of peri-follicular vascularisation and to characterise the biological role of VEGF for hair growth, angiogenesis, and follicle cycling. VEGF is a very important growth factor that plays an important role in mediating angiogenesis. A significant increase in peri-follicular vascularisation during the growth phase (anagen) of the hair cycle, followed by regression of angiogenic blood vessels during the involution (catagen) and the resting (telogen) phase. Peri-follicular angiogenesis was correlated with the upregulation of VEGF mRNA expression of the outer root hair follicle sheath. This strongly induced peri-follicular vascularisation, resulting in accelerated hair regrowth after depilation and increased size of hair follicles and hair shafts. These results identify VEGF as a major mediator of hair follicle growth and cycling and provide the first direct evidence that improved follicle vascularisation promotes hair growth and increases hair follicle and hair size (study). The below study also reports how active hair growth is associated with angiogenesis (study).
The article below relates to how blood vessels hold the key to figure hair regrowth. It goes on to say, in pattern hair loss, it is not that the follicles are gone, just miniature follicles. If we could find a way to make the follicles bigger and more active, this may be able to promote hair growth again. A few scientific studies have suggested that people with hair loss may have fewer blood vessels. But no one had actually measured how closely blood vessel growth is correlated with hair growth, or what might cause scalp vessels to grow in the first place. A few years back research looked at a comparison of two groups, one normal and one genetically programmed to produce an abundance of a protein known to trigger blood vessel growth, VEGF. The VEGF-enhanced group grew hair faster and thicker in the first two weeks of life than did the control group. The VEGF-enhanced group also regrew hair faster. Shaved 8-week-old VEGF-group not only grew hair back sooner, they exhibited a 30 per cent increase in hair follicle diameter 12 days after depilation. Blood vessels located in the skin surrounding the pumped-up hair follicles were 40% larger in diameter than those found in normal cases, suggesting that the VEGF-mediated angiogenesis was causing the hair to grow faster and thicker.
As for how the VEGF-inspired blood vessels are plumping up the hair shafts, the researchers believe they may be delivering an extra supply of growth factors, in addition to oxygen and nutrients.
THE ROLE OF PRP IN THE TREATMENT OF HAIR LOSS
The use of platelet rich plasma (PRP) during and after hair transplant surgery has the potential to act as a bio-stimulus to the transplanted hair. PRP is a rich source of anagen-maintaining growth factors, such as insulin-like growth factor 1 (IGF-1), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF). Injection of PRP derived from a good processing source has been demonstrated in numerous cases to improve various conditions that have impaired blood flow, and to increase vascular structures around hair follicles. During a study using PRP during hair transplant for male pattern baldness patients, a considerably significant effect of platelet growth factors on the follicular hair units over non-PRP used conventional hair transplants has been identified. Thus, indicating that PRP can help to improve and achieve quicker results.
DUTASTERIDE TREATMENT FOR HAIR LOSS
Here at the Dynamic Clinic, we now have a NEW and exciting additional treatment to combat against hair loss - Topical Dutasteride Mesotherapy. The combination of PRP treatment alongside an effective DHT blocker is often advised to increase success rates. Further information can be found here Dutasteride Mesotherapy and Ultimate Hair Loss Treatment Package
Advances in Regenerative Stem Cell Therapy in Androgenetic Alopecia and Hair Loss: Analysis on Cell Growth and Hair Follicle Development
Hair tissue engineering and stem cell therapy are relatively new approaches to treating hair loss. Methods using exogenous cell sources or progenitor cells are now being used for treatment with good clinical success. Specifically, intra-surgical cell treatments that incorporate autologous cell-based treatments with a single simple approach consisting of cell harvesting, minimal manipulation, and immediate injection into a single technique which has the potential to offer tremendous outcomes. A few varying diffident methods have now achieved clinical application. The intra-surgical cell treatment process involves tissue collection and preparation to obtain the desired cell product, followed by careful evaluation using the clinical application,
Bio-Molecular Pathway Disorder
Hair loss is determined by many different factors like genetic influence, hormonal dysfunction (including thyroid, and insulin resistance), autoimmune, nutritional, environmental factors, stress and ageing. Ongoing clinical requirements are required for the advancement of biotechnology to enhance hair growth to address dysfunctional issues. The aim of hair tissue engineering is developing new autologous advancements to induce hair regrowth by bio-stimulation. Autologous stem cells (SCs) have been of particular interest for application in hair regrowth. Alopecia includes modifications to two sorts of hair stem cells, represented by the hair follicle stem cells (HFSCs) and the dermal papilla cells (DPCs). HFSCs and DPCs guarantee conditions for appropriate hair recovery and regeneration.
Find out about MICROGRAFT TRANSPLANT below
HOW STRESS & ANXIETY INFLUENCES HAIR LOSS
Stress, including anxiety-caused stress, can cause hair thinning and loss. There are many reasons why stress causes hair thinning and hair loss, including:
Stress activates neuroendocrine-immune circuits, which terminate hair growth
Stress enhances inflammation that can affect hair growth
Stress induces adaptive immunity cytokine imbalance characterized by a shift to Type 1 T-helper cell cytokine, which can affect hair growth
Stress increases the apoptosis of epithelial cells, which can also affect hair growth
Stress hormones affect other hormones: Hormonal changes can cause hair thinning and loss. For example, androgenic hormones (such as testosterone and its related hormone DHT) affect hair growth. The presence of androgens can cause some hair follicles to regress and die.
Telogen effluvium: chronic stress causes hair follicles to enter a resting phase. Affected hairs can fall out suddenly within a few months when combing or washing hair.
Alopecia areata: stress can cause the immune system to attack hair follicles, which can cause hair loss.
Telogen effluvium is one of the biggest causes of stress-related hair loss. It is a scalp disorder characterised by diffuse, non-scarring hair loss. It has been proposed that there are five different functional types of telogen effluvium based on alternations in particular phases of the follicular cycle. Ultimately, it is caused by an abnormality in the normal hair cycle, which is triggered by numerous factors which can be stress, physical, mental, or chemical in nature.
FERRITIN AND HAIR LOSS
Serum ferritin is a screening tool for iron deficiency. Low serum ferritin can lead to anaemia. While hair loss is not the most common symptom of iron-deficiency anaemia, it does affect approximately half of those with low ferritin stores. Hair follicles hang on to ferritin. When the body is low in iron, it can pull ferritin from places like hair follicles, resulting effect is diffuse hair loss. If hair loss is related to insufficient iron in the body, correcting anaemia should promote hair regrowth. But first, screening for low serum ferritin levels is very important, because supplementing with iron when iron levels are normal or high can result in iron overload and toxicity.
AA is caused by an autoimmune disease that results in the loss of the immune privilege of hair follicles. Many studies have identified that PRP administered either alone or in comparison to steroid has been a very successful treatment for AA. Standard interventions for AA have mostly involved immunosuppressive routes and have significant relapse rates and side effects. Relapse rates have been to be reported at 30% and 70% have been reported for corticosteroid injection treatment in limited AA. Topical steroids have resulted in increased relapse rates, along with oral steroids. PRP has been shown to provide significantly better results in one study
The mechanism of PRP in AA treatment is thought to be a combination of anti-inflammatory effects, immunomodulatory mechanisms induced by growth factors and cell increase. No other side effects of PRP were reported in AA treatment.
NUTRITIONAL DEFICIENCIES IN HAIR LOSS
Hair loss is a common problem that may be improved with vitamin and mineral supplementation. Vitamins and minerals are important for normal cell growth and function and may contribute to hair loss when they are deficient. While supplementation is relatively affordable and easily accessible, it is important to know which vitamins and minerals help treat hair loss. Androgenetic alopecia, and telogen effluvium are two common types of hair loss. Studies show that supplementing the diet with low levels of vitamin D can improve symptoms of these diseases. If a patient has low iron levels, supplementation is also recommended. These iron-deficient patients should also ensure their vitamin C intake is appropriate. At present, there is insufficient data to recommend zinc, riboflavin, folic acid, or vitamin B12 supplementation in cases of deficiency. Neither vitamin E nor biotin supplementation is supported by the literature for treating hair loss; in addition, biotin supplementation can also lead to dangerous false laboratory results. Studies show that too much vitamin A can contribute to hair loss.
Alopecia areata (AA) occurs when the immune system attacks the hair follicle. Studies have shown a relationship between AA and low vitamin D levels. Vitamin D should be supplemented if levels are low. However, more studies are needed to determine the effect of iron and zinc supplementation on AA patients. There is currently not enough data to recommend supplementation of folate or B12. Biotin supplementation is not supported by available data for the treatment of AA. It is unclear if selenium plays a role in this disease; therefore, supplementation with this mineral is not recommended.
Iron, vitamin D, folate, vitamin B12, and selenium are vitamins and minerals that may be involved in hair greying/whitening during childhood or early adulthood. Supplementing these deficient micronutrients can improve premature greying.
SEBORRHEIC DERMATITIS AND HAIR LOSS
Seborrheic dermatitis is a very common chronic skin condition that causes patches of itchy, red, flaky, greasy skin, often resulting in dandruff. It occurs as a result of an overproduction of thick sebum, an oily by your sebaceous glands. The full causes are not fully understood however, it is thought to be a combination of genetics, immune system issues or inflammation, resulting from stress or poor diet, hygiene. This dry, itchy scalp can often be a cause of the hair loss.
Two biopsy-proven cases of primary scarring alopecia caused by cicatricial alopecia and lichen planopilaris have been reported. Both cases have shown that they responded well after three injections of PRP at four-week intervals. Six months after treatment, maintenance treatments are recommended frequently. For cicatricial alopecia, the anti-inflammatory effects of growth factors from PRP as well as their ability to remodel collagen may be a contributing factor to the success.