Tresses and distresses

Hair and its numerous disorders and treatment was the topic when the Western world’s largest-ever conference on hair research convened in Jerusalem recently.

A hair story 311 (photo credit: MCT/Heather McKinnon)
A hair story 311
(photo credit: MCT/Heather McKinnon)
All but the most well-endowed sometimes suffer a “bad-hair day” – but some unfortunate people, especially those who inherit certain defective genes – have a bad-hair life.
Hair interests everybody; just google the word and find 1.43 billion mentions. Hair is a constant worry for many people, including those who have too little, too much, lose it from disease or medical treatment or damage it with improper hair care.
But it seems to be an obsession for the 400 dermatologists and non-physician scientists who took part in the four-day 15th Annual Meeting of the European Hair Research Society (EHRS), which convened in Jerusalem recently. Presided over by senior dermatologist Prof. Abraham Zlotogorski, director of the hair clinic at Hadassah University Medical Center in Jerusalem’s Ein Kerem and director of the hospital’s Center for Genetic Diseases of Skin and Hair, the meeting attracted over 450 experts in the field, about half of them from Israel.
“It was the Western world’s largest medical and scientific conference on hair to date,” Zlotogorski told The Jerusalem Post in an interview at the Ramada Jerusalem Hotel conference location. “They came from 30 countries, and it was the first in Israel,” he said. The international advisory committee included hair researchers and dermatologists from South Korea, Austria, the UK, the US, China, Switzerland, India, Spain, Australia, France and China. “And as most of the foreigners had never been to the country before and some thought there was fighting in the streets, we turned them into Israel lovers. They were enthralled by what they saw on tours we organized during free time,” Zlotogorski added. The first EHRS conference was in Brussels in 1989, while next year it will convene in Barcelona, Spain.
DERMATOLOGISTS STUDY and treat hair diseases and conditions as part of their specialty, said the Jerusalem expert, but it takes much more work to really delve into them, because hair is so complex.
There are only a handful of such experts in Israel, he said. “The past two decades have seen a turning point for hair research, from a subject dealt with only in hair salons and pharmacies to a leading subject in medicine,” he continued. “Research goes into such detail that it touches molecular biology. Hair is one of the most fascinating organs in the body. There are few organs that undergo such renewal, with cells dying and then growing again,” Zlotogorski enthused. It is said that half of all men over 50 will suffer from the thinning or loss of at least 50% of their hair, but the Hadassah expert says that “100% of people will suffer from hair thinning.”
He himself went to the US to study hair after completing his medical degree at the Hebrew University-Hadassah Medical School in Jerusalem, and has not turned back since, even though he continues to deal with skin disease in his Hadassah clinic.
TRICHOLOGY (from the Greek words for hair and any branch of science) is the official name for the specialty, although in some countries there are “hair practitioners” who are not scientists or physicians at all but call themselves trichologists.
The Hair Research Society of India even issues a biannual publication called the International Journal of Trichology and devoted almost half of its latest issue to abstracts from the Jerusalem conference. This is ironic, Zlotogorski said, as Indians have more hair on average than Caucasians. “It’s the only medical journal I know of that devotes itself to hair, but of course many general and dermatology journals have articles on the subject,” he said.
Zlotogorski noted that in recent years, the study of hair diseases – especially its loss – has advanced significantly. Doctors take a medical history, perform a physical exam and refer to lab tests on strands of hair, blood samples and genes. There is even a new tool called a trichoscope, like a dermascope for diagnosing skin diseases and growths, just for the specialty. The younger a dermatologist is, the more likely he is to have the $1,000 device.
Forensic trichology can determine the approximate age, body mass, race and other important traits of a hair’s “owner.” People born with brown or black hair have an average of 100,000 hairs on their head, compared to 120,000 for blonds (although theirs tend to be somewhat thinner) and 80,000 for redheads.
The average person has five million hairs all over his body except for the lips, palms and the soles of the feet. It takes about a month for healthy hair to grow a centimeter in the anagen phase; catagen is the regressing phase; and telogen is the resting phase.
Most hairs grow for up to six years and then fall out, to replaced by new ones.
“Trichology is a subspecialty of dermatology,” explained Zlotogorski, “but there isn’t even one country where it is officially recognized. The Israel Medical Association’s Scientific Council doesn’t either, although I am sure it eventually will. At present, hair disorders are part of the work of dermatologists, who also treat venereal diseases.”
There are lots of jokes about hair problems, such as “the floor is the only thing that can stop hair loss,” and Zlotogorski is frequently stopped in the street by people worried about their hair. But people with heart problems don’t demand to be treated immediately, which is what happens when there is a hair problem.
“They don’t have patience.
Hair, or the lack of it, is so visible.
When cancer patients undergo chemotherapy that causes hair to drop out, it worries most patients more than the disease itself,” said Zlotogorski.
Hair loss is the main problem that brings people to his clinic, he continued. There are many causes, from male and female pattern baldness, autoimmune and genetic/systemic diseases to having a baby, taking medications and psychological problems such as stress and psychiatric disorders like trichotillomania, in which people compulsively pull out their hair.
FORTUNATELY, dermatologists have more tools today, but treatment is usually temporary unless taken regularly. In general, men – whose hair loss is related to the hormone testosterone – have more options than women, but there is some help for women as well.
Inherited hair disorders are apparently caused by a multiplicity of genes, making them more difficult to treat, but there are some rare genetic disorders that come from only a few genes. Zlotogorski himself succeeded recently in discovering with his research team a rare genetic disease he called CANDLE, and an article on it will soon be published in a prestigious journal.
The most common cause of hair loss in humans is androgenetic (or androgenic) alopecia – variants also show up in chimpanzees and orangutans. In humans, it is best known as “male pattern-baldness,” with loss of hair starting above both temples and at the crown of the head. Women do not suffer from classic male-pattern baldness; their hair may become thinner all over the head, but especially at the top, said Zlotogorski, and the hairline does not recede. Fortunately, total baldness is rare in women.
Nearly all the drugs for androgenetic hair loss were discovered serendipitously, as a beneficial side effect of other drugs. One was the active ingredient in minoxidil, originally meant for hypertension. “Someone wrote a letter to the New England Journal of Medicine about the side effect 40 years ago as an incidental finding. The lotion, which is being sold in a few other countries as a cheaper foam, helps balding men only, but if application stops, the hair drops out. Finasteride, an synthetic antiandrogen that inhibits type II 5-alpha reductase (the enzyme that converts testosterone to dihydrotestosterone (DHT)) is meant for both men and women. It delays this conversion and brings hair back, as DHT causes hair loss.
A more severe and unpleasant hair disease is alopecia areata. It causes round patches of hair loss and can lead to total loss on the scalp. The cause is still unknown, but about 20% of people with this condition have a family history of alopecia, which is thought to be an autoimmune disease. It occurs in men and women equally, and even in children. There are no Israel data on prevalence, but it is thought to affect 1.7% of the adult population. “Only the dark hairs fall out, not the white ones,” said Zlotogorski, who added that linkage studies of family members or association studies of individuals who suffer from the same condition have been performed. “We don’t know exactly where the gene is, but we know the region on the chromosome. Clinical studies are being conducted on a drug used for psoriasis.”
Prof. Amos Gilhar, head of the skin research lab at the Technion-Israel Institute of Technology’s Rappaport Faculty of Medicine, told The Jerusalem Post at the conference about his work on alopecia areata.
“Years ago I did implants from people with the disease and put them on nude mice. They grew hair. It hadn’t been clear whether it was a systemic or autoimmune system disease. I showed that it can grow outside the body. It results from several genes, and there is still no cure. Drugs like cyclosporin and other steroids can relieve the condition, but won’t cure it. The disease can appear all over the body, even the eyebrows.
Having it can result in exemption from military service. All autoimmune diseases like this involve a receptor called NKG2D. The aim is to reduce the number of receptors. More research has to be done.”
Certain races enjoy much less hair loss. Africans and Asians, for example, are much more endowed than Caucasians, said Zlotogorski. While Jews and Arabs are no different than others in hair-loss diseases, consanguinity (inbreeding of cousins) among Arabs and some hassidic Jews can lead to genetic hair disorders; there are Caucasians that have the woolly hair natural to blacks, he said.
“Some people claim that using a cellphone causes hair loss, but that’s nonsense. Others say Israeli men have more because life in Israel is hard, but that is silly as well.” But Zlotogorski agreed with some complementary medicine lectures at the conference, such as one on meditation.
One of the most severe hair diseases is scarring alopecia – a disease that destroys hair cells and does not allow them to regrow. “There is an inflammatory process that leads to scars. I see dozens of people a week at my hair clinic – it is a referral center for a large area – but fortunately only two or three with this condition, which is being researched.”
Zlotogorski says evolution over the next 1,000 years could result in much less body hair and more hair on the head. Or maybe it will make bald heads sexy in the eyes of women. But those who can’t wait so long should look forward to drugs that will increase hair growth.
Although his work did not involve hair diseases, biology Prof. Robert Hoffman of the University of California-San Diego – who founded the oldest freestanding biotech company, AntiCancer, in the city 27 years ago – had fascinating things to say. He has spent years researching stem cell markers in the brain that were called Nestin. Incredibly, Hoffman discovered them in abundance in human and murine hair follicles. They can differentiate into neurons, muscle cells and others, and thus “could eventually become an easily accessible source of adult stem cells to produce new organs – even to repair spinal cord injuries.”
With hair, the sky is the limit, and it’s all in your head.