Notes from the ISHRS 2009 Conference, Part 1

I just got back from the 17th annual scientific ISHRS meeting (basically a hair transplant doctor’s convention), which went on from July 22-26. Lots of information was presented… lots of lectures, presentations, and discussions. This year’s meeting was in Amsterdam, so I had quite a long flight back to California when it was all over and I was able to do a write up on the plane of what I learned. I thought I’d share…

Treatments

Dutasteride:
Review of the Korean study for this drug indicates that it is safe and effective drug with side effects consistent but slightly higher than those in the finasteride study. The tests, however, did not study the impact of this drug on sperm count. One doctor present at the meeting reported two patients who had become sterile while on the drug (one being his son). Both men, upon stopping the drug, found their sperm count returned to normal. The failure to study sperm count is, in my opinion, a major oversight in the Korean study from a safety point of view. Based upon this private report, I will not prescribe dutasteride without at least 2 years of treatment on finasteride or a frank failure of the finasteride. I will require that anyone getting a prescription from me (each case would be individualized) would have to sign a legal document that states they recognize that sterility is a possible side effect and risk of the drug.

Finasteride:
Finasteride limits Type 2 receptors for 5 alpha reductase, which reduces the incidence of cancer of the prostate… not the risk of developing prostate cancer. The information available only covers a 7 year period and longer term studies are not available. It is unknown if this drug will reduce the risk of prostate cancer.

PRP:
The use of platelet rich plasma (PRP) was a theme for many scientific papers. We have known that for topical use on skin wounds, this PRP has shown value in accelerating healing when applied. Studies for its application for alopecia areata was suggested by one doctor and a few doctors have started to soak the grafts in the plasma of patients to see if the grafts grew sooner, looked more robust and had a high “take” rate. I would not trust the conclusions of these doctors without a good scientific study to back up their observations. For the moment, I would call this “human experimentation”.

Prostaglandin:
Dr. Bessam Farjo presented a paper on prostaglandin receptors in the stimulus of hair growth. The drug latanoprost has been successfully used to grow eyelashes and is now FDA approved for this (in the form of bimatoprost), but the actual mechanism for what has been observed is unknown. It clearly increases the hair length, rate of hair growth and pigment in the treated lash, and there is a suggestion that there may be applications of this drug in the treatment of hair loss with a bit more research. Some early research by Dr. Farjo suggests that this may very well work as a stimulant for hair growth and in future treatments for hair loss.

General

Female hair loss:
One paper by Dr. Neil Sadick showed a finding in over 80% of women with hair loss that suggested an autoimmune type of process may be in play. He suggested that the exact cause of this autoimmune reaction may be a reaction induced by some unidentified triggering event. We have seen types of microscopic findings in such diseases as coronary artery disease which may have initially been triggered by some infection in the plaques found in the wall of the arteries. The suggestion is that it is this inflammatory process which is causing narrowing of the coronary arteries. If Dr. Saddick is correct, hair loss may be amenable to treatments similar to those offered from diseases like systemic lupus.

Hair growth cycle:
Dr. Dominique Van Neste gave the most significant presentation of the meeting, by developing a way to follow the growth of human hairs over days, months, or years. Using sophisticated computer imaging and analysis software, the entire life cycle of many hairs can be seen from their earliest appearance as a thread of hair arising from a new anagen part of the hair cycle to a mature terminal hair and then through the loss of the hair from the beginning of the telogen and shedding process. With these tools, the impact of drugs like minoxidil or finasteride can be shown modifying the hair cycle. What has been shown is that new hairs rarely arise from drugs like finasteride or minoxidil, but that the impact on the hair thickness and the rate of hair growth may reflect the changes the naked eye sees. This tool has great promise in testing multiple herbal products on the market (probably hundreds of natural based products) that are found in fruits and vegetables. Claims on the effectiveness of such herbal products can either become validated or put to sleep once-and-for-all.

HairDX:
HairDX, through Dr. Sharon Keene, will produce a pilot study to determine the connection between the gene found on the X chromosome in females and the CAG repeat score suggesting the sensitivity to blocking the androgens when they are positive for genetic balding. The arguments are two fold:

1. Does the female who is balding have a androgen mediated disease (abnormality)? If that would be the case, then drugs like finasteride (in these women) may be effective for the treatment of balding. In the various studies with finasteride, the results varied widely.
2. For those women who are CAG repeat positive (suggesting that this subset of women may get a good response from the treatment of DHT blockers like finasteride), will the use of finasteride actually help them with their hair loss? This will be an ongoing study over the next few years.

Read Part 2!