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Tretinoin Retin-A and Hair Loss

Tretinoin is a kind of vitamin A derivatives. It is a kind of topical preparation commonly used to treat acne vulgaris, fine lines, age spots and other visible signs of ageing. Tretinoin when used in combination with topical minoxidil is also a well known treatment for hair loss in both men and women.

Tretinoin has been shown to enhance cell and vascular proliferation. It is commonly referred to as a great exfoliator for the skin. Technically speaking, it works by altering the follicular epithelium (the outer layer of skin) so that it doesn't keratinize (form a hard compact layer). Studies have shown that Retin-A alone can result in moderate hair growth in some patients. When used in conjunction with topical minoxidil, Retin-A seems to be able to enhance the penetration and absorption of minoxidil. This may have to do with the fact that by preventing keratinization, Retin-A decreases the protective barrier of the skin and makes it more able to absorb medications that are put in direct contact with the skin. According to Dr. Lewenberg, "Topical tretinoin appears to increase the beneficial effects of minoxidil, and it is thought that this is due to increased absorption of minoxidil through alteration of the stratum cornum barrier."

Also, one study showed a triple absorption of minoxidil with 0.05 tretinoin as compared with the controlled group.

Brand Name: Retin-A.

Side effects: Tretinoin is well tolerated among most patients. It is very safe when used in accordance to your doctor's supervision. Stinging, redness or peeling of the skin may occur. Adverse effects may subside as your skin adjusts to the medication. Avoid direct exposure to sunlight.

Clinical studies:

1) Bazzano GS, Terezakis N, and Galen W: Topical tretinoin for hair growth promotion. J Am Acad Dermatol 15:880-883, 1986

Topical all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil has been tested for the promotion of hair growth in 56 subjects with androgenetic alopecia. After 1 year, the combination of topical tretinoin with 0.5% minoxidil resulted in terminal hair regrowth in 66% of the subjects studied. Tretinoin was shown to stimulate some hair regrowth in approximately 58% of the subjects studied. One female subject with pronounced alopecia for more than 20 years had regrowth of hair using only tretinoin for a period of 18 months. Tretinoin has been shown to promote and regulate cell proliferation and differentiation in the epithelium and may promote vascular proliferation. These factors are important for hair growth promotion. These preliminary results indicate that more work should be done on the role of retinoids in hair growth. The synergistic effect of retinoids in combination with a low concentration of minoxidil should also be further investigated.

2) Ferry JJ, Forbes KK, LanderLugt JT and Szpunar GJ: Influence of tretinoin on the percutaneous absorption of minoxidil from an aqueous topical solution. Clin Pharmacol Ther 47:439-46, 1990

3) Lewenberg A. Treatment of alopecia with a minoxidil-tretinoin combination. Adv Ther. 1991;8:190-198. Topical application: Use in conjunction with topical minoxidil simultaneously for hair indications.

Dr Adam Lewenberg treated 484 people with a mixture of topical minoxidil and tretinoin. After two years of treatment "cosmetically satisfying" results were obtained in about 90% of these people. In an article written by Dr Lewenberg about his studies, Dr Lewenberg noted the following: "Unlike Minoxidil which effects on the vertex of the scalp, the combination of Tretinoin and Minoxidil results in hair growth in all regions of the scalp."

4) Remox Study The Author of this study wished to confirm the efficacy of ReMox(a combination Of Tretinoin and Minoxidil ) as a stimulant for hair re growth ,increase in hair volume And tensile strength of individual hairs in cases of alopecia androgenetica(AGA).

18 men between age of 20-45 with varying degrees of AGA participated in a double blinded study for a period of 12 months. Each subject was randomly assigned to either the ReMox group or to a newly developed over the counter medication.

Neither the author Or the subjects knew the nature of the treatment they were receiving. Each client was seen monthly, the scalp was examined and hair counts were measured under 6 times magnification and photographs were taken .The results, after 12 months based on hair counts, objective reports by the participants and visual evaluation by both the author and subjects were consistent with expectations. There was an overall improvement of 96% in overall hair count, volume and tensile strength both in the temporal and vertex areas A surprising and unexpected result, was that, the new over the counter hair re growth medication was almost as effective as ReMox producing a 93% increase in hair count in both the temporal and vertex areas. .This may indicate a totally new approach to stimulation of hair re growth in individuals suffering from alopecia androgenetica.

5) Retinoids: compounds important to hair growth. Author: Terezakis NK, Bazzano GS. Dermatology Research Foundation, Los Angeles, California.

Although the mechanisms of follicular regression in androgenetic alopecia are not fully understood, retinoids may be important in changing the status of regressing follicles. There are many reports documenting reversal of epithelial dysplastic changes with retinoids. Although none of the studies with retinoids have concentrated on the precise mechanisms of follicular growth (regression or regeneration), these limited observations, and our early studies suggest that further work should be done on the effect retinoids have on the hair follicle during the various growth and regression phases of the follicular life cycle in humans. We propose that certain retinoids increase the rate of hair growth, prolong the anagen phase of the hair cycle, play a role in converting vellus to terminal hairs, and act synergistically with minoxidil to produce more dense hair regrowth from regressing follicles than either compound alone. Larger controlled studies and better methods for assessing hair growth are necessary to support these early results. Other retinoids as well as certain minoxidil analogs should also be studied.

6) Retinol Produces Changes in Skin Similar to Those Produced By Retinoic Acid, But Without Irritation.

Human skin increases the thickness of the epidermis, enhances expression of CRABP-II (cellular retinoic acid binding protein) and CRBP (cellular retinol binding protein), and causes accumulation of retinyl esters, but does not increase retinoic acid levels or cause erythema. ROL, vitamin A1, is the predominant retinoid in circulation. Clinically, topical application of RA has been used for many skin abnormalities, including acne and photodamaged skin, but its application produces mild erythema and stratum corneum peeling. A retinoid with activity similar to RA but without the local irritation would be of interest. In the U.S., ROL has been widely used in cosmetics and considered safe and is thought to be the prohormone of RA, in that RA is formed from ROL by a two-step enzymatic process. Thus, Kang and colleagues asked whether ROL could achieve RA-like effects in skin. They used a patch-test procedure that involved four days of occlusion after topical application of ROL and of RA. They found that ROL may be a good substitute for RA because it was much less erythemogenic than RA, produced epidermal hyperplasia, increased the expression of both cellular retinoic acid binding protein (CRABP-II) and cellular retinol binding protein (CRBP) mRNAs and proteins, and was actively metabolized and stored as retinyl ester, but did not result in significant accumulation of RA.
7) Retin-A is a prescription drug used for the treatment of several skin conditions.

Retin-A is a prescription drug used for the treatment of several skin conditions. It is one of the most effective drugs in the treatment of acne. Clinical trials showed a side effect of some hair regrowth. Many doctors claim that when used in conjunction with Rogaine/Minoxidil, it increases the effectiveness over minoxidil alone 10% or more. One of the ways Retin-A works is by ensuring proper functioning of the sebaceous glands. The sebaceous glands produce sebum on the scalp. Sebum contains DHT which is then reabsorbed into the hair follicles to do further damage. Proper moderation of the sebaceous glands and their production of sebum can help control skin scalp DHT levels, preventing androgen related hair loss. Retin-A also functions to promote cell growth and ensure the proper functioning of other parts of skin cells.

8) Treatments for androgenetic alopecia and alopecia areata: current options and future prospects. Meidan VM, Touitou E. Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel.

Common disorders of the hair follicle which may heavily influence self esteem and self image. Androgenetic alopecia is caused by the heightened sensitivity of scalp follicles to dihydro- testosterone whereas alopecia areata is induced by an autoimmune reaction. Current drug treatment approaches include the use of regrowth stimulators such as topical minoxidil and oral finasteride for androgenetic alopecia, as well as topical minoxidil, dithranol (anthralin), corticosteroids, contact sensitisers, and psoralen plus ultraviolet A irradiation (PUVA) therapy for alopecia areata. Combination regimens are also proposed. However, extreme cases of either type of alopecia do not generally respond well to these existing treatments. For this reason, new therapeutic strategies are directed towards both improving the targeting of existing agents, as well as the development of novel hypertrichotic modalities.

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