Fabio and Chris,
This paragraph is from Uno's HISTOPATHOLGY OF HAIRLOSS and deals with the immuno attack:
"In alopecia skin, tha abnormal streamers underneath the follicles appear to be a structural barrier for the down-growth of anagen follicles. Moreover, severe inflammatory involvement in the streamers causes suppressive growth of the follicular bulb and dermal papilla cells. Dense collagenous or hyalinized scarring streamers block the growth of follicles. These follicular structures naturally resist any therapeutic effect for follicular growth. Moreover, associations of focal perivascular and perifollicular inflammatory cell infiltrations are often seen in alopecic skin."
A guy called THE ALMIGHTY GOD OF HAIRLOSS, who like Bryan Shelton, has read tons about the condition wrote the following paragraph about Uno's work with human vs. macaque baldness. I proboably learned more reading the following than I did in a couple of months research on my own (because TAGHL is alot smarter than I am). Enjoy:
Androgens, male pattern baldness, and human vs. macaques"
Guys,
Hideo Uno, an expert on male pattern baldness, published an OUTSTANDING paper on human vs. macaque baldness. I was very glad to read this paper, because it validates everything that I have said and thought regarding male pattern baldness.
If you read nothing else in this post, PLEASE (I beg you!) read the excerpts written by Hideo Uno, which are VERY, VERY important, and explains the key to fighting male pattern baldness in the most successful way possible. It also explains why some people don't respond to treatments like dutasteride. Anyone who wants a thorough understanding of human alopecia should read this entire post carefully!
This post will also prove what group of users are most credible in this forum. That is, it shows that myself, Bryan, Marco, Frizz, etc. have been right all long. The foremost experts in the world verify what we've been telling you all these months.
CommoneSense, I think Dr. Uno's statements are going to shock you, but more importantly, they are going to educate you on male pattern baldness. After reading his comments, I sincerely hope you change your outlook and recommendations on the treatment of male pattern baldness.
In this paper, Hideo Uno covers the histopathology of both macaque *AND* human baldness. Despite what some uninformed readers say, human baldness is a complicated disorder which involves more than just androgens.
Point number one: The histopathology of human and macaque baldness, while similar, HAVE SOME KEY DIFFERENCES.
We know that macaques respond more favorably to baldness treatments than do humans (especially to antiandrogen treatments). And we know that the response rate among macaques is remarkably consistent; i.e., they all get similar results (in contrast to humans, where we see greatly varying results among individuals).
So, why do macaques get better and more consistent results? Because macaque baldness is purely a genetic and androgen-driven disease. Human baldness is much more complicated, hence decreased results and a whole range of responses to various treatments.
Why is human baldness more complicated? For starters, human baldness involves inflammation and fibrosis. In macaque baldness, inflammation and fibrosis is absent among all macaques (source: Uno's study below). This is a key difference between macaque and human baldness. And since inflammation generates a slew of potent hair growth inhibitors (IL-1, TNF-alpha, TGF-beta1, etc.), and since fibrosis scars the structure of the follicle itself, this explains the difference in results between humans and macaques. Also, macaques are not exposed to other factors which inhibit hair growth, like stress, smoking, poors diets/insulin resistance, etc.
Don't believe me? Hideo Uno verifies everything I've said above. Keep reading....
Point number two: all of those who think that antiandrogens are the be-all and end-all of treatments are severely misguided, and do not understand the pathology of human pattern baldness.
In particular, CommonSense (and other like-minded readers) has long dismissed the involvment of factors other than androgens and genetics. He wants you to believe that androgens are the ONLY factor involved, and the ONLY factor we should address. Also, he continuously downplays any other approach to fighting male pattern baldness, such as antiinflammatory and anti-fibrotic treatments.
So, who to believe? Me, Bryan, Frizz, Marco, etc., or CommonSense? Well, I will let the experts tell you in their own words. To make a long story short, CS is completely misguided, and below is the proof from one of the foremost experts on hair loss in the world.
So, without further ado, here is some excerpts from Hideo Uno:
Citation:
Androgenetic alopecia in the stumptailed macaque: an important model for investigating the pathology and antiandrogenic therapy of male pattern baldness. Hideo Undo, etc. al. Chapter 11, Hair and its Disorders: Biology, Pathology and Management; published by Martin Dunitz Ltd, 2000.
Excerpts (in qoutes):
"... However, our recent comparative studies on the histopathology of human and macaque androgenetic alopecia revealed critical differences in pathological manifestations between these two counterparts (19)."
My comment: this next excerpt is a very important point that everyone should know about.
"The histopathological changes of the human androgenetic alopecia have been described by many investigators. Besides a miniaturization of follicles, fibrogranulomatous or collagenous streamers are beneath the follicles, together with focal perivascular and perifollicular inflammatory cell infiltrations, and varying degrees of fibrosis have been reported (Table 1)."
My comment: this next excerpt has more IMPORTANT details on human male pattern baldness, and why some people simply fail to respond to treatments.
"In alopecia skin, tha abnormal streamers underneath the follicles appear to be a structural barrier for the down-growth of anagen follicles. Moreover, severe inflammatory involvement in the streamers causes suppressive growth of the follicular bulb and dermal papilla cells (see Figure 8a). Dense collagenous or hyalinized scarring streamers block the growth of follicles (Figure 8b and c). These follicular structures naturally resist any therapeutic effect for follicular growth. Moreover, associations of focal perivascular and perofollicular inflammatory cell infiltrations are often seen in alopecic skin."
My comment: Dr. Uno now summarizes the pathology of macaque baldness. Please note that it is different than human alopecia in that hair loss develops evenly, whereas in humans there are many different patterns of hair loss, and that alopecia in macaques develops very rapidly, whereas in humans it's much, much slower. Additionally, there is NO INFLAMMATION IN macaque baldness.
"In the macaque, alopecia develops evenly in the entire frontal scalp during a relatively short period after the elevation of androgens during puberty. In the macaque alopecia, the histopathological changes comprise simply of miniaturization of the follicles, with those follicles remaining in telogen for a long period. There is no inflammatory involvement in the dermis and no adnormal streamers underneath the follicles, unlike the human counterpart."
My comment: Dr. Uno now says macaques respond better to treatments than humans, based on all of the available data.
"... However, presumably because of the different pathological backgrounds between macaque and human alopecia, macaque alopecia responded more strongly and homogeneously than human alopecia (Table 3)."
My comment: A VERY IMPORTANT, key point here by Dr. Uno.
"Furthermore, in human androgenetic alopecia, therapeutic approaches cannot simply rely on either hypertrichotic or antiandrogenic agents or even a combination of both. For further therapeutic improvement, it may be necessary to use combined treatment with antiandrogenic and antiinflammatory, as well as anti-fibrotic agents; hypertrichotic agents, such as minoxidil, or other potassium channel openers in addition, may enhance efficacy."
My comment: To sum it all up, here are Dr. Uno's conclusions. This paragraph is EXTREMELY IMPORTANT!!!!!!
"... Nonetheless, the complexity of the pathological changes in human androgenetic alopecia appears to hamper the effects of these hair growth-stimulating agents. Thus, results obtained from the macaque, which has no such complications, usually show much greater and homogeneous effects than those obtained in human alopecia. The pathologoical changes associated with regressed follicles in human androgenetic alopecia have been described by many investigators. However, more studies on the histogenesis of inflammatory streamers, dermal lymphocytic infiltrations, and the process of focal fibrotic changes are necessary to fully define this disorder. For further improvement of therapy, combined pharmacological interventions may be needed to reduce or prevent inflammatory and fibrotic processes in human alopecic skin."
Regards,
The Almighty God of Hair loss
