Finasteride Use by Young Men: Not only for Baldness in the Crown !

Finasteride Use by Young Men

For years, we've largely assumed that finasteride helps men with hair loss in the crown, but does little for men with hair loss in the front of the scalp or the temples.

A new study by US researchers has nicely shown that finasteride 1 mg daily can help young men with male pattern balding regardless of where on the scalp the man has hair thinning.

The researchers studied men 18 to 60 years of age for a period of two years. Four areas of the scalp were examined: (1) vertex (crown), (2) the mid-scalp, (3) the frontal hair line and (4) the temples.

What were the results of the study?

The study showed that young men benefitted from taking finasteride - regardless of where there hair thinning occured. Young men (age 18-40) with hair loss in front, temples, mid-scalp or crown all had benefit from taking finasteride. However, the same was not true of men age 41-60. Men in this slightly older group benefitted most if their hair loss was in the crown and the mid-scalp.

Reference

Olsen EA et al. Global photographic assessment of men aged 18 to 60 with male pattern hair loss receiving finasteride 1 mg or placebo.  J Am Acad Dermatol 2012; 67: 379-86. (click for abstract)

 

Genetic Balding in a 6 and 8 year old?

Genetic Balding: How young does it  affect?

Androgenetic alopecia ( also known as genetic /hereditary balding) occurs in 50 % of men and 30 % of women by age 50.  Genetic balding can occur in teenagers but rarely occurs under age 11.

Italian dermatologists recently published an interesting report in the journal Pediatric Dermatology.  They described two healthy sisters aged 6 and 8 years who presented with a one year history of hair thinning which the dermatologists diagnosed as androgenetic alopecia.  Lab tests were normal in these two girls.Treatment with 2% minoxidil was successful in improving hair density.

Comment:

Although androgenetic alopecia is rare in the pre-teen years, it may rarely occur.  In these rare situations the first occurance is just before puberty during a period of hormonal change called "adrenarche." A strong genetic predisposition is often found... and the mother of the two girls in the study also had early onset of androgenetic alopecia at age 18.

Reference

Familial Androgenetic Alopecia in Siblings with Normal Endocrinologic Status. Pediatric Dermatology. Vol 29.  p 534-35.

Does Sunlight Worsen Androgenetic Alopecia? Lessons from the Police

Sunlight Worsens Androgenetic Alopecia

Androgenetic alopecia, or male pattern balding, is common.  In fact, about 50 % of men will have androgenetic alopecia by age 50. It is well known that genetics and hormonal influences play an important role in men.                                      

But what about other factors?                                                                                                                         

The role of ultraviolet radiation in male balding has been debated for many years and we still don't know all the answers.  However, many scalp diseases are made worse by ultraviolet radiation.  For example, my patients with seborrheic dermatitis will often report flares following sun exposure.  In addition, patients with discoid lupus or dermatomyositis  may note worsening after sun exposure.

The exact role of ultraviolet radiation in male balding is not clear.  We know that inflammation is present under the scalp in many men with genetic hair loss and so the question arises... How did that inflammation get there? ...  and is their any possibility that sun exposure contributes to the inflammation that is found under the scalp in men with balding?

An interesting study from researchers in Taiwan offers further clues that sunlight just 'might' contribute in some way to male balding.  The researchers compared balding patterns in 758 policemen  and 740 men in the general polulation.  Interestingly, policemen aged 40 to 59 had a two fold increased risk of having male balding. In addition, there was a statistically significant association between male balding and sunlight exposure.

More research is needed understand if and how ultraviolet radiation affects the process of male balding. If a link is found, it will be important to determine if men who reduce sun exposure (with hats, etc) will slow down the natural progression of the male balding process.

Su et al. Androgenetic alopecia in policemen: Higher prevalence and different risk factors compared to the general population.  Arch Dermatol Res 3: 753-61.

 

Alopecia Areata Occurring After Age 50

Alopecia areata affects all age groups. In fact, one-half of individuals with alopecia areata develop their first episode of hair loss before the age of 18.

Over the past 20-30 years, we have come to understand that a wide range of autoimmune diseases can occur in patients with alopecia areata. For example, previous studies have taught us that up to 20 % of patients with alopecia areata have thyroid disease and about 50 % of patients with alopecia areata have an itchy skin condition known as atopic eczema. In addition, we now know that a family history of alopecia areata occurs in about 10 to 20 % of patients.

Alopecia areata is an autoimmune disease. Many different autoimmune diseases behave differently in older individuals than younger individuals. We don’t know exactly why this occurs but it may be because the immune system changes as we get older.

But what about alopecia areata? -

Does this condition have different characteristics in those who first develop the condition after age 50?

Do older patients differ from younger patients with alopecia areata?

A New Study from Taiwan

Researchers from Taiwan set out to determine the characteristics of individuals who developed their first episode of alopecia areata after age 50.

Their study consisted of 73 patients with alopecia areata. All patients developed their first episode of hair loss after age 50. Two-thirds of the patients in the study were female and one-third of the patients were male. Approximately one-third were found to have thyroid abnormalities and one-quarter had a skin condition, like nail pitting or atopic eczema. None of the 73 patients had a family history of alopecia areata.

Conclusions

 
All in all, this small study suggested that older individuals who develop their first episode of alopecia areata may have slightly different characteristics compared to younger individuals. Although more studies (and larger studies) are needed to definitively prove this, but it appears that alopecia areata first occurring in older individuals:

• tends to be a milder type
• may be slightly more likely to affect women than men
• may not have as strong of an association with skin eczema or a family history of alopecia

 Reference 

Title of Study: Wu MC, Yang CC, Tsai RY and Chen WC. Late-onset alopecia areata: A retrospective study of 73 patients from Taiwan. Journal European Academy Dermatology Venereology 2012;

Hair Greying and the 50-50-50 Rule

The process of hair greying is a fascinating process. (For my US friends, I’m talking about the “graying” of hair). I’ve lost count how many friends, family members and colleagues have commented about grey hair in the past week alone. Grey hair is common (and getting more common) so let’s talk about it.

I can’t clear up all the myths associated with grey hair in this blog. But the three most common myths are:

• Plucking a grey hair causes more new ones to appear - False!

• Individuals with grey hair are less healthy than those with darker hair - False!

• Getting grey hair is related to stress - False!

What age do we start to grey?

The age that our hair turns grey is determined by several factors. The most important factor, by far, is our genetics. If there are alot of individuals in the family with early greying, there is a very good chance you’ll go grey early too. President Obama started going grey in his late 40s and he once remarked to the media that his own grandfather was grey by his late 20s.

The normal process of hair greying starts in the temples and then the crown. Caucasians starting greying first (sometimes in the 30s) followed by Asians (in the late 30s) followed by those with African descent (in the mid 40s). In general by age 50, about half of the Caucasian population has at least 50 % grey hairs. I refer to this as the “50-50-50 Rule:"

By age 50, about 50 % of the Caucasian population will have 50 % grey hair (commonly referred to as salt and pepper hair).

Rapid Greying (turning white overnight)

You may have heard stories of hair turning grey (or white) over night. These stories usually focus on the great deal of stress experienced by the person.  What is going on here?

It's not actually possible for a dark hair to suddenly become white. Rather, what is happening is that the dark hairs are falling out leaving behind the white hairs to be seen.  This pattern of sudden greying may be seen in patients with a condition called alopecia areata.

Premature Greying of Hair (PGH)

The term "premature greying" of hair refers to hair greying that occurs before the age of 20 in Caucasians, before 25 in Asian individuals and before 30 in black men and women.  I occasionally evaluate patients in my clinic who start greying in the teens or twenties. These individuals usually have an underlying genetic or systemic abnormalities. Many, many factors influence hair greying. Thyroid abnormalities, B12 deficiency are just two examples of many conditions that cause early greying.  Smoking too can cause early greying. In fact, a 1996 study in the British Medical Journal showed that smokers are about two to four times more likely to have grey hair.

Why does hair turn grey?

Hair doesn't actually 'turn' grey color, but simply loses its original color. Grey hair occurs because a pigment called melanin stops being pumped into newly manufactured hairs. It’s a specific cell called a melanocyte that is responsible for producing the melanin. The reasons why this change occurs is complex and continues to be the topic of research around the world.

Grey hair is actually different than the neighbouring darker hairs. In other words, a grey is not simply a normal hair that lacks pigment. The hair shafts seem to be different. Anyone who has grey hair will notice that the hairs are frequently wirier, coarser and less likely to hold pigment in hair dyes than the neighbouring pigmented hairs.

The Future of Grey Hair

The main treatment for greying hair, at present, is hair coloring and hair dyeing. At present, we spend over 2 billion dollars a year on hair coloring products in North America.

With an aging population, I’m sure we will soon see increasing demand for new ways to color our hair in years to come and even more focus on understanding the molecular and genetic process of greying. At present we have about 40 million individuals in the US and Canada aged 65 and over. By 2050, this number may be approaching 90 million.

What treatments will be available for grey hair in 2050?

I'll be following with you!

References of Interest

1. Premature grey hair and hair loss among smokers: A new opportunity for health eduation. British Medical Journal 1996; 313: 1616

2. Data in graph extrapolated from US Census Data. http://www.aoa.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Population.aspx