Hair biology and its clinical relevance

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The clinical relevance of hair biology

Clinical relevance

If you want to learn about hair disorders you need to understand the normal state of hair biology and hair growth first. If you do not know what “normal state” means, you can not identify the “abnormal” characteristics. From ages many evaluative studies on hair follicles have been conducted. There are those highly detailed studies of histologists over 150 years ago as well as the advanced genetic analysis of today. All of them have significantly contributed to the unveiling of many secrets of normal hair follicle development, growth, and cycling. Today we are equipped with a solid understanding of the essential principles of hair biology - still there is much more to learn.

The identification of key pathogenetic events in common hair diseases heralded a major breakthrough in our understanding of hair biology. These key pathogenetic events include the altered androgen response and subsequent hair follicle miniaturization in androgenetic alopecia or perifollicular inflammation involvement in alopecia areata and lichen planopilaris. The complex interplay of signalling events in hair growth and cycling, make the hair follicles extremely sensitive to endogenous influences, like hormonal imbalances, systemic diseases, or nutritional defects. Hair follicle growth also gets affected by environmental factors such as stress, pathogens, or impairment of mitotic activity caused by drugs. All these environmental influences result in changes in hair shaft calibre and ultimately culminates into breakage of hair fibers. Massive impairment of hair growth on the other hand is the result of excessive or continuous exposure to toxins and that ultimately leads to loss of dystrophic anagen hair fibers.

For both the trichologist and the patient, the information on hair biology, hair formation, and cycling is not enough - the understanding of the pathogenesis of clinically apparent hair disorders and the course of disease is also equally important. The patient should be furnished with such information and educated on their disease---this tremendously helps the doctor to improve compliance during treatment. For example, these information make sense for the patient as to why, topical minoxidil treatment in androgenetic alopecia frequently requires regular application over the course of several months before a recovery of hair growth can be evaluated - an informed patient knows it is due to the hair growth kinetics.

Outlook – future developments

Advances in molecular biology and gene expression profiling have also made significant breakthroughs - now we know about the genes and signalling pathways involved in hair growth and hair cycling. New avenues have been opened in the area of complex regulation of hair follicles. This finding in turn has led to a more finely defined understanding of the pathogenesis of diseases such as alopecia areata and androgenetic alopecia. However, the current therapeutic concepts are still rather unspecific in their action. This necessitates the current researches to be aimed at the development of more focused strategies involving specific, targeted treatment of the various manifestations. A branch of study for example, tries to find solution in sub-grouping of patients on the basis of gene expression profiling to help determine the most effective therapeutic option for each individual patient.

The scientists are building up their knowledge on the various signalling pathways involved in hair growth. This branch of knowledge is believed to further lead to the identification of new drug targets, and open up the possibilities for invention of new set of drugs. As for example, the treatment of psoriasis is expected to be revolutionized with the development of biologicals. The development of novel drug delivery systems would be aimed at a better penetration of active compounds directly into the hair follicles. It will be easier for these drugs to target the specific compartments within the hair follicles, thus outpacing the efficacy of established treatments. These novel drugs are also expected to give rise to new therapies with a reduction of side effects. And above all, advances in stem cell isolation and purification may enable the future scientists in bioengineering hair follicles to provide a foolproof hair replacement therapy in cases where conventional treatments fail.

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