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Hair Loss/Various shampoos shown to help hair loss

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QUESTION: Dr. Panagatacos,

Are you aware of this study?

Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations.
Piérard-Franchimont C1, Goffin V, Henry F, Uhoda I, Braham C, Piérard GE.

Abstract
Hair shedding and hair thinning have been reported to be affected by dandruff and seborrhoeic dermatitis. The present study was conducted in 150 men presenting with telogen effluvium related to androgenic alopecia associated with dandruff. They were randomly allocated to three groups receiving each one of the three shampoos in the market containing either 1% ketoconazole (KTZ), 1% piroctone olamine (PTO) or 1% zinc pyrithione (ZPT). Shampoos had to be used 2-3 times a week for 6 months. Hair shedding during shampoo was evaluated semiquantitatively. Hair density on the vertex was evaluated on photographs using a Dermaphot. Trichograms were used for determining the anagen hair percentage and the mean proximal hair shaft diameter using computerized image analysis. The sebum excretion rate (SER, mug cm(-2) h(-1)) was also measured using a Sebumeter. The three treatments cleared pruritus and dandruff rapidly. At end point, hair density was unchanged, although hair shedding was decreased (KTZ: -17.3%, PTO: -16.5%, ZPT: -10.1%) and the anagen hair percentage was increased (KTZ: 4.9%, PTO: 7.9%, ZPT: 6.8%). The effect on the mean hair shaft diameter was contrasted between the three groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: -2.2%). In conclusion, telogen effluvium was controlled by KTZ, PTO and ZPT shampoos at 1% concentration. In addition, KTZ and PTO increased the mean hair shaft thickness while discretely decreasing the sebum output at the skin surface.



**It seems like rotating ketoconazole and piroctone olamine shampoos would help male pattern baldness sufferers. Since they decreased sebum output in the 6 months of the study it would also seem they are antiandrogenic? The study also has 150 participants so statistics are more believable. What are your thoughts?

ANSWER: At the annual International Society for Hair Restoration Surgery meeting held in 2004 it was I who made the announcement to the several hundred participant in an open forum that the study done by Proctor and Gamble about 1999 or 2000 in which they found increased density after using 1% ZnP solution daily for one year. Their conclusion was that it was due to a cleaner scalp.
 My contention< which was later proved to be true, was that all Zinc Salts inhibit the 5 alpha reductase enzyme and therefore there would be less DHT in the hair follicles leading to less Androgentic Alopecia at the end of the year.  In 1994 in an online interview with Regrowth.com -- which I am unable to find on the web anymore, I stated Ketoconizole shampoo would also lower DHT in the scalp because it interferes with the Testosterone metabolism pathway. In both instances my comments were met with some scepticism at first and then studies were done proving these statements to be true.
 So, to answer your question, YES, I was away of these studies and my thoughts are that they are not looking the results from the right perspective. It is the lowering of the DHT which causes move hair density not the lowering of the amount of seborrheic dermatitis, not the amount of sebum.

---------- FOLLOW-UP ----------

QUESTION: I respect the fact that you are aware of and openly recommend alternative treatments and ancillary options for treating hair loss such as using shampoos proven to help MPB and prescribing Avodart to patients no longer responsive to finasteride. I visited 3 seperate dermatologists to try and get a prescription for Avodart and none of them were willing to prescribe it for MPB. Two out of the three did not even know about Avodart for treating hair loss. I even showed them the Phase II studies done by the FDA but they still refused to prescribe it to me. I had to resort to using a family friend that is a doctor to get a prescription.

Back to these medicated shampoos.... I notice they make my hair somewhat unruly. Would I still be able to get the benefits of these shampoos if I lather up with the medicated shampoo first, let it sit for roughly 5 minutes, rinse then follow up with a more conditioning/volumizing shampoo?

Also, what matters more in regards to slowing hair loss: lower serum DHT, or lower scalp/pilosebaceous DHT levels? Does the fact that there is less blood serum DHT levels mean there is lower scalp/pilosebaceous DHT?

thanks

Answer
I have had patients complain of dry hair after the use of DHS zinc shampoo and they seem to be happy with REVIVOGEN CONDITIONER following the shampoo. Reviogen also has ingredients which lower the DHT level in the pilosebaceous unit.
  I try to lower the DHT in the serum before it gets to the hair as well as lowering the level in the hairs themselves. It seems to me to be more important to lower the serum concentration by 66% than the levels in the pilosebaceous units by the same amount.
  Patients attempting to get by with just topical treatment never seem to reach the same goal as those who only used medications to lower the serum level.

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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