Gone today, hair tomorrow
AN APPLE A DAY - AN APPLE A DAY By Tyrone M. Reyes, M.D. () - November 14, 2006 - 12:00am
Dead housefly mixed in coconut oil. Dog urine. Pigeon droppings. Cow saliva.

Through the ages, Filipino men losing their hair have resorted to desperate measures to recover the luxurious tresses of their youth – but happily today, their options have expanded substantially beyond dog urine. Now, there are sophisticated transplant techniques and drugs which have proven to be more than mere snake oil.

And there’s more to come. High-tech remedies are on the horizon – ones that may solve the shortcomings of today’s solutions, which, for the most part, consist of saving hairs that already exist or moving them around on the scalp. Researchers are beginning to understand how hair grows and why they stop 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 will solve all of our problems," says Dr. Claire Haycox, clinical associate professor of medicine at the University of Washington in Seattle.
Hair History
Hair serves no fundamental biological purpose. It doesn’t keep us warm or shield us effectively from the sun. But there is no question that hair plays a huge role 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 a 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.
Hair Loss
Typically, men start losing 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. People normally lose around 100 hairs a day. The average scalp has 100,000 hairs.

The cause of baldness lies within the hair follicle, a microscopic pocket in the skin. Hair sprouts from the 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 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 not so well-liked.

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 are still there – the hardware is intact; it’s more of a software problem."
Hair Remedies
The US FDA has approved two remedies for that software glitch:

Minoxidil (Rogaine), approved as a baldness treatment in 1998, was the first truly effective treatment in the long history of remedies for hair loss. It jumpstarts 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.

Finasteride (Propecia), approved by the FDA in 1997, is better understood. It stops the formation of DHT in the scalp. DHT is a by-product of testosterone and is tagged as the hair-loss culprit.

Dermatological studies show that extra-strength Rogaine (5% minoxidil) thickens hair overall and even causes some regrowth in 60 percent of men after one year of use. Propecia stops hair loss over a five-year period in 90 percent of men and leads to 14 percent 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 percent 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. And that’s hardly the stuff of heady dreams.
Hair Treatments
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 US 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 animal’s skin. A thick patch of hair developed quickly – far faster than it should have naturally (see photo on Page D-1). Curis has started to develop this drug for humans. It has applied to the FDA to start safety trials late this year or next year.

Meanwhile, the Aderans Research Institute (ARI), based in Atlanta and Philadelphia, and Intercytex, a British biotechnology company, have successfully grown dermal papilla (DP) cells of the hair in their lab. 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 top of the scalp.

"We’re growing human hair, and we’re growing it on human skin," says Ken Washenik, ARI executive vice president.

Intercytex, meanwhile, has started testing its cells on human heads. Last year, it conducted a clinical trial mostly to ensure the procedure was safe.

With these new developments, 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.

But they’re not using dog urine anymore. 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 epidural growth factor, which can stimulate cells in the follicle to make hair grow 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 and herbal shampoos – may finally end.

No one will need cow saliva anymore – except the cow.

ADERANS RESEARCH INSTITUTE AMERICAN ACADEMY OF DERMATOLOGY ANGELA M ATLANTA AND PHILADELPHIA BALD CENTER COLUMBIA UNIVERSITY HAIR HAIRS
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