More options are available to address alopecia, but not all are backed by equally solid science. Strategies for choosing and using new treatments and procedures for full-cycle hair loss management were highlighted at the Music City Symposium for Cosmetic Advances & Laser Education 16th Annual Meeting.
Hair loss has a lengthening list of complex causes in male and female patients, ranging from genetic predisposition and androgen imbalances to physical and mental stress and COVID-19. In response, the mechanisms of action and scope of treatment options are expanding exponentially. However, not all these therapies demonstrate equal efficacy and safety, according to panelists presenting on full-cycle hair loss management at the Music City SCALE Symposium for Cosmetic Advances & Laser Education 16th Annual Meeting, August 18-22, 2021, in Nashville, Tennessee.1
This track outlined the treatments which show the most promise, how to select and use these options, and how to prepare for further COVID 19-related impact on hair loss as the pandemic enters a new phase.
Harness Regenerative Medicine’s Potential
Regenerative medicine has “amazing,” untold potential as an emerging therapy, said Michael H. Gold, MD, founder of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center, and Tennessee Clinical Research Center located in Nashville, Tennessee during his presentations on hair loss at the SCALE conference.2,3 However, he cautioned that this potential could dissipate if dermatologists do not do in-depth homework.
For example, Gold pointed out that platelet-rich plasma (PRP) is a huge play in dermatology currently and while having demonstrated positive outcomes in other aesthetic rejuvenation procedures, the technique also has proven itself to be a very effective treatment for hair loss.
Although an ever-increasing number of companies offering PRP kits claim their product to be top shelf, Gold noted some do not back up their positions with peer-reviewed studies, publications, and authenticated scientific research. The FDA has cracked down on pseudo-science-oriented products, but physicians still need to be wary regarding which PRP products they choose, he added.
“The products we choose need to be backed by sound science with clinical trials that are best performed by dermatologists and/or medical professionals in the field who specialize in hair and treatments for hair loss,” Gold said. “I believe the aesthetic and dermatology companies out there have slowly but finally understood that we as medical professionals demand this for our patients.”
Prescription medications such as finasteride, non-prescription remedies such as minoxidil, special diets—including high-dose protein, vitamin D, biotin, and iron supplements—can be useful adjunctive therapies in addressing alopecia, according to Gold.
Nutraceuticals also have proven their efficacy in stemming hair loss and helping regrow hair, said Gold. However, he recommended that physicians search for nutraceutical products from reputable companies and use products that are backed by placebo-controlled clinical trials that include hair counts to back their claims.
Additionally, more innovation is on the horizon. In July, the FDA cleared an Investigational New Drug Application (NDA) for Kintor Pharmaceutical’s novel drug GT20029 for treatment of androgenetic alopecia (AGA) and acne subjects. GT20029 is the first topical Proteolysis Targeting Chimera (PROTAC) compound globally to have entered the clinical stage.
“Hair loss therapy is a booming business today and for male and female patients with most types of alopecia, PRP, nutraceuticals, and other products in the pipeline are giving hope,” Gold said. “If you are going to be in the regenerative medicine space no matter if it’s injectables, topicals, or pills, you need to do [your] homework.”
COVID-19 and Hair Loss
Hospitalized patients with COVID-19 present and diagnosed with androgenetic alopecia are more frequently found than expected in an aged-matched control groups, and the underlying pathology is likely due to androgens, said Andy Goren, MD, chief medical officer at Applied Biology, Inc., in Irvine, California, in his presentation on hair loss at SCALE.4
Recent data have shown that patients with higher tissue androgen levels are likely to suffer from more severe COVID-related symptoms according to Goren. This discovery has led to clinical trials, both of genetic and androgen assessment of COVID-19. Among key factors being studied are anti-androgens, specifically using androgen deprivation therapeutic drugs against COVID-19.
In his hair loss research, Goren noticed that male patients are disproportionately affected compared to female patients, but prepubescent pediatric patients are not affected at all. In his view, this appears to implicate an androgen level imbalance in affected individuals.
Androgens play a pivotal role in hair loss but not in “COVID effluvium.” “Stress related to the pandemic can cause telogen effluvium or ‘COVID effluvium’, which in all likelihood will reverse itself to normal hair growth once the stress factor is gone,” Goren said.
Closer investigation suggested a link between androgen response and coronavirus. Goren and his team found that, in order to enter the type II pneumocytes in the lungs, SARS COVID-2 requires an enzyme to cleave the virus, mainly TMPRSS2.
“The only known promoter of this enzyme in humans is regulated by an androgen response element, and this honed our focus on androgens and androgen receptors, which is the first thing you think of in androgenetic alopecia,” Goren said.
In 2 successive observational studies5-6, Goren and his colleagues found that men with COVID-19 who had been hospitalized with the virus, had less hair than expected in that corresponding patient population. As a result, baldness was established as an increased risk factor for more severe COVID-19 infection, re-enforcing the premise that pandemic-related hair loss is related to androgens, not stress.
This finding led to the hypothesis that androgen receptor genetics—how androgens are regulated—might predict risk for COVID-19 severity.
“From a dermatology perspective, this finding was incidental and is interesting because the connection to baldness and androgenetic state seems to impact the severity of COVID-19 disease,” Goren said. “Nevertheless, it is not surprising because the influenza virus is also thought to be influenced by androgens. In fact, studies demonstrated that androgens attenuate vaccine efficacy. So, it’s not just COVID-19.”
In a retrospective analysis, researchers then began working with the dual 5-alpha-reductase inhibitor dutasteride for potential COVID-19 treatment and studied the medication’s effect in a cohort of dermatology patients who were taking the drug for more than 6 months—imparting a protective effect—compared to patients who were not on the drug.
Following positive results from the analysis, the researchers then turned to using the drug in patients who were hospitalized for COVID-19 and taking androgen deprivation therapy, which offers a more potent and faster-acting means to reduce androgens in the body.
Proxalutamide (Kintor Pharmaceuticals), a second-generation androgen receptor antagonist, as well as HC-1119 (Hinova Pharmaceuticals), an androgen receptor inhibitor, used in COVID-19 patients are currently in phase 3 trials (NCT04728802 and NCT04986176, respectively). If they gain FDA approval, these drugs could represent a completely new therapy for COVID-19 infection, according to Goren.
As a result of his research, Goren recommended that patients experiencing hair loss should speak with a dermatologist, as this could be a sign that they may be at a higher risk for COVID-19 severity. A multidisciplinary approach would be the best route for optimal patient care, he concluded.
Goren and Gold reported no relevant financial disclosures.