We contacted Dr. Kevin McElwee, owner of Keratin.com and asked him to write
an article for us on how detrimental inflammation and sebum production is
to the hair loss and hair loss treatment process. Here was his reply, and
his very elaborate article:
"Well you opened a real can of worms with that
article suggestion. It is a complex situation and you will find different
dermatologists saying different things about the significance of inflammation
in AGA (Androgenetic Alopecia, or Male and Female Pattern Baldness). I have
spent a few hours trying to knock it into shape and as a result it has gotten
rather long. Feel free to hack the article down to size."
The technical stuff...
When looking at tissue biopsies from human scalp skin it is fairly common
to see inflammatory cells. Inflammatory cells are part of our immune system.
They should always be there. We need them to protect against viruses and bacteria
that can get into our body through wounds. Healthy skin should contain a lot
of what are called dendritic cells and Langerhan’s cells. These cells
form part of our primary immune defense. They are involved in what is called
“immunosurveilance”. In other words, these cells migrate through
the skin constantly checking our cells and other material they find to make
sure there are no foreign proteins present, particularly foreign proteins
from bacteria and viruses. There are even some inflammatory cells inside the
upper regions of the hair follicle. They probably look for pathogens that
might try to take up residence in the hair follicle canal.
More Inflammatory Cells in the Scalp than Elsewhere
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Inflammatory Cells |
Scalp skin contains more clusters of inflammatory cells than you would see
in non-scalp skin. These cell clusters are often very close to follicles, and
they contain other immune cell types that would not normally be seen
in healthy skin. Many times they contain things like mast cells, lymphocytes,
and sometimes neutrophils. While there are always a few of these cells in healthy
skin, seeing them in greater numbers on the scalp is a rather worrisome sign.
When inflammatory cells increase in number they are usually responding to something.
The cause of the greater clustering on the scalp isn't totally understood. It
could be a response to some change in the skin or hair follicles, or it could
be from an outside factor entering the skin.
Not many studies have been done to look at these cell clusters. Three are mentioned
in the footnotes of this article. These small studies generally involved taking
biopsies and looking at the numbers of inflammatory cells around hair follicles.
By comparing the frequencies of cell numbers in alopecia affected and normal
scalp skin, most of the authors concluded that inflammation might contribute
towards the hair loss. However, there is a flaw in this reasoning.
These studies always look at the inflammation after hair loss had developed.
They didn't take into account the possibility that changes in the hair follicle
DURING hair loss may attract the cells, and an inflammatory response. So there
is a lot of argument among dermatologists over whether scalp inflammation in
AGA actually contributes to AGA. Some well respected dermatologists believe
that it does, while others say that scalp inflammation is common and seen even
when AGA is not present.
(Continued on the next page...)
- Legitimate Proven Hair Loss Treatments for Men
- Legitimate Proven Hair Loss Treatments for Women
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Sebborrheic Dermatitis and Hair Loss
Many people who experience Androgenetic Alopecia (male and female pattern baldness)
express concern about a tingling and itching that can vary in severity from
a slight tingling to an extremely annoying inflammation. It has been hypothesized
that this itching, which almost always seem to appear at the onset of MPB, is
a response to the hormonal changes going on in the scalp. Even in the absence
of MPB, dermatitis on its own will result in a mild telogen
effluvium type hair loss, so in the presence of MBP, dermatitis can significantly
speed up the speed of your loss and inhibit the effectiveness of your treatments.
Both AGA and dermatitis are quite common and it is quite possible to have both
conditions together. Many people do. In fact, it has been hypothesized that
even in the absence of any noticeable itching, this same inflammation can exist
on a smaller scale and should be treated with a shampoo like TGel or Nizoral.
If you have a combination of both AGA and a the itch of dermatitis, then successfully
treating the dermatitis will not only slow down the speed of your loss, but
it will help with your hair growth. It would not stop progression of the underlying
AGA, but it would give some degree of hair growth improvement. There are two
main kinds of dermatitis to consider, seborrheic dermatitis and contact dermatitis.
Seborrheic dermatitis involves an inflammatory response to the oils produced
by the sebaceous glands while contact dermatitis is the result of exposure to
some allergic factor – most often a chemical in a shampoo or conditioner.
Both types of dermatitis can cause a fungal infection that makes things worse.
Anti Inflammatory in the Propecia Trials
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When studies on Propecia were conducted, the drug users were all asked to wash
their scalps with Tgel
shampoo. The reasoning behind this was two fold. First, cosmetic hair products
do affect the look or hair and the trial investigators were going to take global
photographs so they wanted the volunteers to all be using the same shampoo product
throughout the study. Second, the issue of whether
dermatitis could influence the hair growth response to Propecia needed to be
minimized. Tgel is a reasonably effective treatment for dermatitis
(seborrheic or contact) while at the same time it has no known direct stimulation
or inhibition of hair growth. By using Tgel the investigators
could remove the question of whether scalp dermatitis was influencing any hair
growth response to the Propecia use from the clinical trial. Some
think the investigators were worried that Propecia might stimulate dermatitis
itself hence the use of Tgel, but there has never been any official word to
confirm or deny this, and at least to my knowledge there has been no reporting
of dermatitis exacerbation with the use of Propecia.
Why no Nizoral in the Propecia Trials?
Some people wonder why the Propecia trial did not use Nizoral as the shampoo of
choice. The main problem with this was that Nizoral shampoo was not readily available
when the trial started. If the Propecia trial was taking place today when Nizoral
is readily available it probably still would not be used. Although Nizoral is
officially used for treating dermatitis and combating mild scalp fungal infections,
the active ingredient (ketoconazole) has known anti
androgen properties and this may have some positive effect on hair growth.
The objective of arranging a trial to test Propecia was to examine the effects
of the drug, not the effects of Nizoral.
In one small clinical study it was even suggested that the
actions of Nizoral on hair growth were equivalent to the effects of 2% minoxidil
(4).
Nizoral and Tgel are not made by Merck, the makers of Propecia, so they are
not likely to promote the merits of combining Nizoral or Tgel with using Propecia
even though there may be advantanges to the consumer in doing so. However,
many dermatologists will recommend to their patients the use of Propecia, Nizoral
and Tgel. You can use all three in a combined regimen. Nizoral should
not be used more than twice a week. Other days you can use Tgel and normal shampoo
in rotation. The only problem with Nizoral and Tgel is that they can be quite
drying to the hair. You can remedy this with a separate conditioner.
(Continued on the next page...)
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Nizoral, the god of hair loss Shampoo's
 |
Without exception, nizoral is the most successful shampoo on the market today
at not only controlling the itch, but any underlying inflammation you may not
be able to detect, while simulatneously helping stimulate minor hair growth.
No other shampoo we know of can do this. Tgel is another good alternative, but
no regimen should be without Nizoral. You can get Nizoral in the shampoo section
of any grocery store, typically at the end, next to the Rogaine. We suggest
all our users make use of it once every 3 days. Apply it immediately as you
get in the shower, and let it soak for the duration of your shower. After a
few weeks your itching should be gone, and we suggest continuing with it indefinitely.
Its truly the only shampoo out there that can do what it does.
In the natural products isle at the local store you will also find aloe vera
or tea tree lotions. These products can work well, but of course they only reduce
the inflammation and do not treat the underlying cause of the inflammation.
If you stop using them and the underlying promoter of the irritation is still
present, then the inflammation will come back. One word of warning, anti-inflammatory
products do seem to have the potential to promote folliculitis (let’s
call it scalp acne) when they are used for a long time. It is ironic that an
anti-inflammatory product should do this, but it does seem to occur in some
people. If folliculitis develops just stop using the product and it should go
away.
Inflammation and the Effectiveness of your Regimen
At this stage in our understanding of inflammatory cells and their influence
on hair growth we don’t know which inflammatory signals are good and which
are bad. However, it is reasonable to say that if your scalp is irritated/inflamed
AND you see you are losing more hair, then the kind of skin irritation/inflammation
you have is certainly not helping to grow hair and may even be exacerbating
it. The best thing for you to do is make sure you are using Nizoral shampoo
once every 3 days as part of your regimen. Its ability to reduce any noticeable
(and unnoticeable) inflammation will only benefit your progress, and the effectiveness
of your treatment regimen. Having antiandrogenic properties itself, it may also
help stimulate hair growth, and it is literally the only shampoo on the store
shelves today that can do this.
All the above applies more or less equally to men and women. The nature of
inflammation in female AGA has not been investigated in any detail, but it is
quite likely that at least some women have a big problem with scalp inflammation
and this may be contributing to their hair loss. Skin biopsies from women with
AGA can show much the same kind of cellular inflammation seen in biopsies from
men. Women are also susceptible to dermatitis whether contact dermatitis or
seborrheic dermatitis - just like men. If dermatitis seems to be a problem then
medicated shampoos like Nizoral nad Tgel are just as valid for use by women
as by men.
In Conclusion
Some say AGA and inflammation are inextricably linked and part of the same
problem. Some say they are two separate conditions but often found together
in the same person because they are so common. Some say inflammation is a primary
cause of hair loss and others say the inflammation is just a secondary response
to something else that is causing the hair loss. This is all very confusing
and the scientific evidence to prove who is right and who is wrong is not likely
to be produced for a long time. However, if you have hair loss and scalp irritation
together it makes sense to look into reducing scalp inflammation. No one can
say for sure if it will really help hair growth but it should do no harm. Is
it possible that eliminating scalp irritation might stop hair loss completely
for a while? – possibly!
1) Sueki H, Stoudemayer T, Kligman AM, Murphy GF. Quantitative
and ultrastructural analysis of inflammatory infiltrates in male pattern alopecia.
Acta Derm Venereol. 1999 Sep;79(5):347-50.
2) Jaworsky C, Kligman AM, Murphy GF. Characterization
of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis.
Br J Dermatol. 1992 Sep;127(3):239-46.
3) Young JW, Conte ET, Leavitt ML, Nafz MA, Schroeter AL. Cutaneous immunopathology
of androgenetic alopecia. J Am Osteopath Assoc. 1991 Aug;91(8):765-71.
4) Pierard-Franchimont C, De Doncker P, Cauwenbergh G,
Pierard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia.
Dermatology. 1998;196(4):474-7.
- Legitimate Proven Hair Loss Treatments for Men
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