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September 2010

Cloning expected to represent future of hair transplantation


Research under way to determine whether cloning could create thousands of "copycat" hairs from a single harvested hair

Sept 2010

Cloning will represent a major advance in hair transplantation when it is ready for prime time. It remains elusive for now, but new clinical therapies — along with older standbys — are helping hair loss patients in the meantime, according to a leading specialist in hair transplantation.

One of the factors limiting hair transplantation is donor density. Individuals without good donor density can be less-than-ideal candidates for hair transplantation, notes Nicole Rogers, M.D., F.A.A.D., dermatologist and hair transplant surgeon and clinical professor, Tulane University, New Orleans. The potential for cloning leaves physicians hopeful for now.

"That would be the Holy Grail," Dr. Rogers says. "It would be great if we could harvest a single hair from the back (of the head) and create thousands of copycat hairs from that. There is significant research ongoing in that area, but we are not there yet. It's still going to be a while before it is ready for Food and Drug Administration approval."

When cloning comes to fruition, there would still be challenges with controlling the caliber and angle of hair growth. Researchers also would have to be sure cloning did not trigger other skin conditions such as skin cancers, she says.

Combination approach

"There are other variables that need to be investigated," Dr. Rogers says.

When patients present with a condition such as central centrifugal cicatricial alopecia (CCCA), Dr. Rogers may prescribe therapy such as doxycycline or intralesional steroids to control inflammation that is present, and then focus on hair transplantation. For male pattern hair loss, doctors can use medical therapy such as finasteride as an adjunct to hair transplantation.

"We (transplant surgeons) have found it is a wonderful complement to the procedure," Dr. Rogers says. "We can start patients when they are just noticing hair loss, so they can hold on to what they have and regrow a good amount of hair. In conjunction with surgery, finasteride can even reduce the number of procedures that a patient needs."

Dr. Rogers's practice in younger male patients is to prescribe medical therapy for about six to 12 months, and then evaluate whether the patient would still like to undergo transplantation.

"Medication is a good option, because we can't predict their hair loss," she says.

New advances

The NeoGraft hair transplant machine (NeoGraft) is a new device used to aid in the process of follicular unit extraction (FUE). The technology allows clinicians to harvest individual follicles from the back, which must then be dissected. The follicles are removed from the donor area using a punch of less than 1 mm. According to Dr. Rogers, a vacuum-assisted suction device makes harvesting a little easier for doctors.

"Still, it is operator-dependent in terms of how the hairs are placed in the frontal area and what the final outcome is," Dr. Rogers says. "With this device, a prerequisite to success and a very natural result is its use by an experienced hair transplant surgeon."

Clinical therapies

Another development is the use of diabetes medication to treat hair loss. According to report published in the December 2009 issue of Archives of Dermatology, oral pioglitazone, a peroxisome proliferator-activated receptor (PRAR) gamma, demonstrated improvement in patients with lichen planopilaris, a rare disorder that leads to permanent hair loss.

"Scarring alopecias are irreversible, and you have to make sure there is no evidence of inflammation before you transplant these patients," Dr. Rogers says. "This impact of the medication is exciting, because it gives us another understanding to help conquer a difficult condition."

Patients should be advised of potential side effects with therapy in the form of the agonist of pioglitazone, she says.

"It increases the body's sensitivity to insulin, so theoretically, patients could develop hypoglycemia," Dr. Rogers says. She notes there is also a risk of peripheral edema and congestive heart failure associated with use of the medication.

Another new clue to the etiology of hair loss is the recent identification of a gene in the development of hereditary hypotrichosis simplex, Dr. Rogers says. This gene, which helps researchers to better understand follicular miniaturization, may also be used to understand male and female pattern hair loss. If this development offers solutions to other types of hair loss, patients and physicians alike will be better off.

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